IMAXX Student Information Form

Name

School Name and Grade

Birthday

Student Cell

Student Email

Address

Parent/Guardian 1 Name

Parent/ Guardian 1 Cell

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 2 Name

Parent/Guardian 2 Cell

Parent/Guardian 2 Email

Communication

One of the primary methods of communication utilized to inform you of upcoming events and schedule changes is texting. We also frequently use emails, our website, and our First Tabernacle social media pages. At least one cell and one Email is required from parents.

Photo Release

Your permission is required for photographs of the student listed above to be published on the website of First Tabernacle MBC, First Tabernacle social media pages, printed publications, and audio/video presentations of IMAXX student ministry activities for publicity purposes. I understand that these photos can be viewed by anyone in the world, but no identifying information will be displayed. I Give My Permission.

Medical Information

List Allergies (if student has no allergies, enter "none")

Dietary or Physical Restrictions (i.e. Vegetarian, lactose intolerant, etc. If student has no dietary restrictions, please enter “none”.)

List of Medications (No medications will be administered by Student Ministry Leaders. If student is not currently on medications, enter “none”.)

Emergency Contact Name

Emergency Contact Phone

Description

Please fill out this form and click submit.

IMAXX Student Information Form

Description

Please Fix the Following