AMPED Student Ministry Connect Card
Please fill out this form and click submit.
Name
*
Email
*
This address will receive a confirmation email
Cell Phone
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
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GA
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HI
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ID
IL
IN
KS
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LA
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MB
MD
ME
MH
MI
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NB
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VT
WA
WI
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WY
YT
Birthday
*
School
*
Grade
*
I attend
*
Please select all that apply.
8:00 Worship Service
9:30 Worship Service
11:00 Worship Service
Not Sure
9:30 Sunday School
Parent Name
Parent Email
Phone Number
Parent Name
Parent Email
Parent Phone Number
I would Like to receive Text Messages about AMPED Students
*
Please select all that apply.
Yes
I'd rather not
Submit
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