Form Entry

New Student Connection Form

Student First Name

Student Last Name

Student Date of Birth

/ /

Student Gender

Student Phone Number

Student Email

Student Grade

School

Agape is an inclusion ministry at The Crossing that partners with different ministries to ensure all people are included and accommodated so they can learn that Jesus is more. Agape can provide support for individuals with additional needs such as behavioral, social, physical or intellectual needs. If your student would benefit from Agape support, select "Yes".

No Yes

Does this student want to join a small group?

No Yes

Is there a certain friend this student would prefer to be with?

How did you hear about us?

Friend Website Social Media Other

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email

Parent/Guardian Gender

Parent/Guardian Date of Birth

/ /

Parent/Guardian Relation to Student

Do you want to add a second parent/guardian?

No Yes

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If you have any questions please email [email protected].

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