Please fill out entire form and return to heritage student ministries

First Name ____________________________ Last Name ______________________________________

Grade ______ School _____________________________

Cell Phone__________________________ Email__________________________________

Please Circle: Male Female Birthday ______/______/______

• Have you been baptized? Yes No • If yes, what year?______________________

Growth Groups
I am interested in being a host home and would like more information Yes

Please fill out entire form and return to heritage student ministries

Please Circle Any Line That Applies To You

This is my 1st time in a Growth Group at Legacy Iʼve been in a Legacy Growth Group before

I attend Legacy on Wednesday nights regularly I attend Legacy on Wednesdays every now and then

This is my first time being involved in anything Legacy does

Iʼve been involved with Legacy/Heritage a few times before... Please explain ______________________________

_____________________________________________________________________________________________

Parent(s) Name __________________________________ Home Phone __________________________________

Parent(s) Email (required for communication) ________________________________________________________

Parent Permission: As parent(s) and/or legal guardian(s), I/we hereby grant ______________________________
(Studentʼs Name) my/our permission to participate in any Legacy Growth Group activity throughout this semester.
I/We commit to respecting and supporting my childʼs decision in being involved with this ministry at Heritage Church.

Parent Name (Please Print) _______________________________________________________________________

Parent Signature _______________________________________________________________________________