Parental Student Information and Photo Release Form
Student Information
Name:
*
First Name
Last Name
M/F
*
Male
Female
Birthday:
*
-
Month
-
Day
Year
Date
Age:
*
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School:
*
Grade:
*
Parental Information
Father's Name
First Name
Last Name
Father's Cell Phone #
Mother's Name
First Name
Last Name
Mother's Cell Phone #
Photo Release
By submitting this form, I give consent to use my student's photographs for publicity, promotional of NSM and Northminster Church. If you would NOT like your child to be included in any photos that are used both digitally and print, let us know below.
I consent
I DO NOT consent
Submit
Should be Empty: