Student Registration Form
Share student details, grade level, and an emergency contact, and review drop-off timing for Saturday and Sunday.
Student Information
Student's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade Level
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Relationship to Student
*
Please Select
Parent/Guardian
Sibling
Relative
Family Friend
Other
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Saturday, Sunday, or both
Saturday Academic Support 12PM - 5PM
Sunday Youth Ministry 9:00AM - 3PM
Both
Mentorship Night 6pm-8pm
Girls Mentorship Night: Girls of Purpose, Becoming Her Best Self: Friday, November 13, 2026
Boys Mentorship Night: Men of Purpose, Building the Next Generation: Friday, November 20, 2026
Register
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