Student Connect Card

Please enter student information below. Parent information will be entered on a subsequent page.

Campus

First Name

Last Name

Mobile Phone

Birthdate

/ /

Gender

Male Female

Address

Allow Texting

Yes No

Student School

Student 1 Grade

Student Instagram handle

Does your family regularly attend Christ Chapel?

Yes No

Have you been to a Student Small Group?

If yes, who were your leaders?

How did you hear about HSM/MSM?

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