Student Ministry Registration Form

Name

Gender

Male Female

Program Registration

Jr. High Sr. High

Address

Date Of Birth

Grade as of September 2026

5 6 7 8 9 10 11 12+

Health Card #

Health Card Version Code (Two Letters)

Health Card Exp

Student Email (If Applicable)

Student Phone (If Applicable)

Parent/Guardian #1

Relation to Student Father Mother Guardian

Address

Phone

This address will receive a confirmation email

Parent/Guardian #2

Relation to Student Father Mother Guardian

Address

Phone

This address will receive a confirmation email

Student Lives With Father Mother Guardian

Allergies / Medical Concerns / Special Needs

I give permission for the student named above to participate in the events at Kingston Gospel Temple. I give permission for the staff and volunteers of Kingston Gospel Temple to seek medical attention in the case of emergencies.

Yes No

I give permission for the student named above to appear in images or video online or in printed promotional material as deemed acceptable by the staff and volunteers of Kingston Gospel Temple.

Yes No

In cases of emergency, I give permission for the student named above to be transported as needed by the staff and volunteers of Kingston Gospel Temple.

Yes No

I want to receive emails from the KGT Student Ministry program with information and updates.

Yes No

Kingston Gospel Temple is collecting this personal information for the purpose of enrolling your student in our programs, to develop and nurture ongoing relationships with you and your student, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish Kingston Gospel Temple to limit the information collected, or to view your student’s information, please contact us.

Student Ministry Registration Form

Description

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