(LPSM) Student & Guardian Contact Info Form

Student & Parent Information

Help us get to know you better! This info will let us contact you to keep you informed and connected during this school year!
Student Information:
Student First & Last Name*
Student's Cell Phone #
(000) 000-0000
Student Email Address
example@example.com
Student's Birthday*
MONTH / DAY / YEAR
Current Grade*
Expected High School Graduation Year?*
What school does this student attend?*
Please list any extra curricular activities you participant in at school or outside of school:
T-Shirt Size (Adult)*
Student, what social media platforms do you have? (Choose ALL that apply.)*

InstagramTikTokSnapChatFacebookTwitterPersonal BlogMy Own YouTube ChannelNONE
Please list your username(s) or handle(s) to those accounts.
Student, please list a few of your favorite things! (Food/Drink, Things To Do, Places To Go, Music, Experiences, etc.)*
Parent(s) / Guardian(s) Information:
When filling out multiple student information/contact forms, as long as we have your parent/guardian contact information section on at least ONE of the student's form, you can skip the portion below! You do not have to repeat the same information.
Primary Parent / Guardian's First & Last Name*
Primary Parent / Guardian's Cell Phone #
(000) 000-0000
Relation to Student*
Primary Parent / Guardian's Email Address*
example@example.com
Secondary Parent / Guardian's First & Last Name
Secondary Parent / Guardian's Cell Phone #
(000) 000-0000
Relation to Student
Secondary Parent / Guardian's Email Address
example@example.com
Main Home Address*
City*
State*
Zip*
POLL: What is the best way to inform you of LPSM details? Choose ANY that apply. ***** An app called BAND is our main hub of communication & information. If you have never joined and need an invite code to our specific LPSM BAND, please let Pastor Josh know at 502-314-4117.*

Sunday morning worship service announcementEmailFacebookInstagramBAND app parent-specific chat (This requires notifications to be turned on!)BAND app group post (This requires notifications to be turned on!)---> Please send me a BAND app invite.
Are you and your family members at South Campbellsville Baptist Church?

Yes, we are members.No, we are NOT members at South but we do attend and would like to join! Please contact us on how to do this.No, we attend South but are not ready to join yet.No, we attend a different church and we ARE members there.No, we attend a different church but are NOT members there either.No, and we do not attend a church or any other place of worship.
If NO, please list what church your family is a member of AND OR attends regularly, if applicable
What are the ages of any other children and teens in your home?*
Should be Empty:

Student & Parent Information

Student Information:

Parent(s) / Guardian(s) Information: