Student Program Registration Page

STUDENT PROGRAM AND SPECIAL EVENT REGISTRATION
Click here for Special Event Registrations

Student Program Registration Form

Please complete and submit this online form if you wish to be enrolled in our Student Programs

Student Name:

Male

Female

Birthdate:

Month: Day: Year:

Age

Grade

Email:

I give my permission to use my email address for church newsletter and information emailings

Yes

Parent's Name(s):

Phone:

Cell Phone:

Cell Phone Carrier :

Address:

City:

State:

Zip Code:

Is studentbaptized?

Yes No

If so, where:

Are parents members of Church of the Palms?

Yes No

Please sign student up for the following programs:

Sunday "Sabbath"

"Pulse"
for Middle School Students

"Thirty-Three"
for High School Students

Special health concerns/allergies:

Any adaptations made for student in school? (please list)