iMPACT Teens (Ages 13-18)

REGISTER YOUR TEEN:

Weekly encouragement emails are sent to your teen’s cellphone, and we host quarterly in person events.

For more information email fiaministry1@gmail.com.

Teen's Information:

*

School

*

Grade

*

Birth Date

*

Age

*

Gender:

*

Parent/Guardian Information:

Address

*

Email

*

This address will receive a confirmation email

Cell Number

*

Home Phone

Child Health Questions:

Please select one option.

1. Is child presently being treated for an injury or sickness or taking any form of medication for any reason? 2. Is your child allergic to any type of food or medications? 3. Does your child require a special diet?

Select responses to the above health questions:

*

Please select all that apply.

1. Yes 1. No 2. Yes 2. No 3. Yes 3. No

If yes, please explain: Otherwise just type

*

Photo Release:

I hereby give permission for my child to be photographed during interaction and to be displayed for non profit and promotional purposes including use in print, social media and all other forms of media. I understand that although my child's photographs may be used for the purposes above, that his or her identity will not be disclosed. I do not expect compensation and that all photos are the property of New Vision Church.

Photo Release Approval:

*

Please select all that apply.

Yes No

Description

REGISTER YOUR TEEN:

Weekly encouragement emails are sent to your teen’s cellphone, and we host quarterly in person events.

For more information email fiaministry1@gmail.com.

Please Fix the Following

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