Student Info

STUDENT INFORMATION

* Indicates required field

Student's Name *

First

Last

Home Phone Number *

Student's Cell Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

School Attending *

Grade *

Gender *

Male Female

Date of Birth (month/day/year) *

T-Shirt Size *

Special Interests or Hobbies *

PARENT INFORMATION

Mother's Name *

First

Last

Father's Name *

First

Last

Mother's Cell Phone *

Email *

Father's Cell Phone *

Email *

Submit

We Would Love to Have You Visit Soon!

Hours

Sunday Morning Worship -             10:30am
Sunday School -                                9:30am
Sunday Evening Studies -                5:30pm
Wednesday Night Connect - 6:00pm

Telephone

903-657-4362

Email

revchadt@yahoo..com