Student Info Form — Geneseo First Methodist Church

Please fill out all information applicable in order to help us keep accurate records on all our participants in Student Ministry. Paper copies of this form are available upon request.

Student Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

High School Graduation Year and School

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father Name

First Name

Last Name

Father Email

Father Phone

(###)

###

####

Mother Name

First Name

Last Name

Mother Email

Mother Phone

(###)

###

####

Student Cell (Optional)

(###)

###

####

Food Allergies and Health Concerns

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

I give consent for First Methodist to use photos or videos occasionally, of my student, in the group, in social media or church publications.

Yes

No

Will your student be driving themselves?

Yes

No

Does your student have permission to walk home from youth group?

Yes

No

Are there other children/students in your household? If yes, please list Name, Date of Birth, and Graduation Year.

Please list Name, Date of Birth, and High School Graduation Year

Other helpful information to know about your student

Please let us know if anyone other than yourself will be picking up your student.

Please list any additional people who may pick up your student.

First Methodist Church Student Ministry Information/Registration Form