Student Ministries...

2008-09 Jr. High Small Group Registration Form!

To sign up for a Wednesday night Jr. High Energy Small Group,
fill out the form below! See the Energy Page for schedule info!

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PERSONAL INFORMATION:

Name:
Street Address:
City:		State:		ZIP:

Home Phone:
Cell Phone:
Email Address:
IM:
	Age:       Gender:  Female      Male

SCHOOL INFORMATION:

School:
	Year:  6th      7th      8th
School Activities:
Hobbies/Interests:

SMALL GROUP INFORMATION:

Previous Small Group Leader: (if applicable)
Name one friend you really want to be in a Small Group with:
Name a Small Group Leader you'd like to be with if possible: