Illumin8 Student Registration

Illumin8 Registration Form

Illumin8 Student Ministry is available for children 4 years old to Young Adults
How many Student's are you registering?*
Student Information
First Student
Student's Name*

First NameLast Name
Student's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the Student (including food allergies).*
Second Student
Student's Name*

First NameLast Name
Student's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the Student (including food allergies).*
Third Student
Student's Name*

First NameLast Name
Student's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the Student (including food allergies).*
Fourth Student
Student's Name*

First NameLast Name
Student's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the Student (including food allergies).*
Child Release Information
Parent/Legal Guardian Name*

First NameLast Name
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Names of Persons to which the student(s) may be released to each time after student worship/class (Please provide at least two)*

First NameLast Name
Full Name*

First NameLast Name
Full Name

First NameLast Name
Full Name

First NameLast Name
Are there any persons to which the student(s) may NOT be released to?*

YesNo
Who may you student(s) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 1 Phone Number*
Emergency Contact 2 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 2 Phone Number*
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website.

I Agree
Should be Empty:

Illumin8 Registration Form

Student Information

First Student

Second Student

Third Student

Fourth Student

Child Release Information

Media Release