Rooted 2010 - Student Registration Form

February 5-7, 2010 @ Grace Point Church ** David Martin ** Rivenside **
* Separate Form Required for EACH student
* $40 if registered by 1/24/10, $10 late registration fee
* $10 discount for every non-Grace Point friend invited/attending
* Pay online.

Student's Name

Student's Age

Grade

Address

City

State

Zip

Student's Cell/Primary Phone

Student's Email

Gender

Are you a Grace Point Student Ministries member?

Do you attend a church other than Grace Point?

(if so, list name of church)

T-Shirt Size

Parent's Full Name

Parent's Primary Phone Number

Parent's Email

Payment Method

$40/student prior to Jan 24th, $50 after.
For Credit Card Payment use this link. Be sure to check the 'Rooted' box in the 'available funds' section.

Check Number

Parent Authorization

I authorize the above student to participate in this event sponsored by Grace Point Student Ministry. I realize this means travel to and from the event location and any medical emergency that may arise. In the event of a medical emergency, I give Grace Point Student Ministry leaders the authority to obtain medical attention for my student. (type full name and today's date)

Want to Help?

This is a significant event in the lives of students - we depend upon parents like YOU helping make it a success! Here are just a few of the ways you can contribute to making this event a success:

I would like to help by Hosting a small group in my home.
I would like to help facilitate a small group discussion.
I would like to contribute towards scholarships for families unable to afford this event.
I would be interested in helping provide or prepare food for meals during this event (meals in homes).
I want to help somehow, please call me to discuss other options!

Any special needs we need to know about or questions?

Visiting

Who We Are

Leaders

Plugging In

Life Groups

Kids

Adults

Care and Support

Daycare

High School

College

Rooted 2010 - Student Registration Form