|
Student's Name (required)
|
|
| |
|
|
Are you an IPC Member
-or Visitor?
|
|
| |
|
| School Name |
|
| Graduation Year |
|
| |
|
|
Birthdate
(month/day/year)
|
|
| |
|
|
Address
|
|
|
City
|
|
|
State
|
|
|
Zip Code
|
|
|
Home Phone
|
|
|
Student's Cell #
|
|
| Student's e-mail (required) |
|
| |
|
| Parents' Names |
|
| Parents' cell #s |
|
| Parents' e-mails |
|
| |
|
| |
|
|
Who are your some of your closest friends in this youth group?
|
|
|
Would you like to be involved in a small group?
|
|
| |
|
| Fill in the blanks below: |
|
|
Do you play an instrument?
(if so, what instrument?)
|
|
| |
|
|
Do you play a sport?
(if so, what sport?)
|
|
| |
|
|
Do you have other hobbies?
(if so, which ones?)
|
|
