Rise High School Registration Thanks for taking the time to register! Registering gives you the chance to provide us with the basic information that we need to communicate and connect with you and your middle/high school student. Please complete a separate registration form for each student that you would like to register. Grade Student is in (Fall)*9th Grade10th Grade11th Grade12 GradeWhat School Does Your Student Attend?*Student Name* First Last General InformationPlease make sure that you complete the remaining sections of the form.Parent/Guardian* First Last Relationship*Parent/Guardian* First Last Relationship*Address* Street Address City ZIP Code Home Phone*Parent Cell Phone 1*Whose number?*Parent Cell Phone 2Whose number?Parent Email Address* Whose email?*Parent/Guardian: Best Way to Contact?*Home PhoneParent Cell 1Parent Cell 2Parent Email AddressStudent's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student's Cell Phone*Student's Email Address* Student: Best Way to Contact?*Student CellStudent EmailLiability Release, Medical Information and PermissionsPlease complete all fields in this portion of the registration form.Do you give permission to The Way church staff/leader to obtain medical assistance for your student?*YesNoNote: By answering yes to this question, you give permission to the responsible leader and/or staff member at Newton Church of The Way to obtain medical assistance for your child[ren] in the event that you cannot be reached. Furthermore, by answering yes to this question, you release Newton Church of The Way and hold them harmless of any liability in regard to such assistance.Emergency Contact Name* First Last Please include the name and phone number of one personEmergency Contact Phone*Does your student have any special medical needs we should know about? Please list in detail.*Note: Please list any special instructions that should be taken if there are any medical needs that would need tending to.Family Doctor Name* First Last Family Doctor Phone*May we use your student's picture on any Newton Church of The Way: website, Facebook, video or brochure?*YesNoNote: Your student's picture will only be used for Newton Church of The Way ministry purposes.Can we send text messages to the student cell phone number above to update students on ministry events?*YesNoWhat are the names of two people your student would like to be in a small group with?*We will do our best to accommodate small group requests based on the leaders and groups that are available.Get Involved! I can provide snacks I can lead a small group I can help where needed EmailThis field is for validation purposes and should be left unchanged.