CORE [high school ministry] CORE Profession of Faith 2018 CORE Student Registration 2017-2018 CORE Registration Home > CORE [high school ministry] > 2017-2018 CORE Registration Please complete the following form to register your 9th-12th grade student(s) for our high school ministry. If you have any questions, contact Ali Cranmer (High School Leader) at 641-628-4900 x308 or Myra Van Zee (Administrative Leader) at 641-628-4900 x201. Parent Information Parent Name(s): Full Address: Home Phone Number: Mother Cell Phone: Father Cell Phone: Email address: If parents live separately, do you want information and communication to go to multiple addresses? Yes No Permissions Do you give permission to the responsible leader at Third Church to obtain medical assistance for your student in the event you cannot be reached, and do you release Third Church and hold them harmless of any liability in regard to such assistance? Yes No May we use your student's picture on the Third Church website, videos or brochures used for Third Church ministries? Yes No Student #1 Information Student Name: Date of birth (mm/dd/yyyy): Grade (entering in fall 2017): Email address (please enter only if student checks email): Cell phone number: Please list any special medical needs we should know about: If new to CORE or a Freshman, please list two people you would like to be in a small group with. Those returning to CORE will continue with their previous groups. Student #2 Information Student Name: Date of Birth (mm/dd/yyyy): Grade (entering Fall 2017): Email address (please enter only if student checks email): Cell phone number: Please list any special medical needs we should know about: If new to CORE or a Freshman, please list two people you would like to be in a small group with. Those returning to CORE will continue with their previous groups.