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Middle School Bible Study
with Ascension Press "Encounter"

Contact Information:

Father's Name

Home/Cell Phone

Email

Mother's Name

Home/Cell Phone

Email

Street Address

Zipcode

Emergency Contact

Emergency Phone

Relationship

Child 1:

Child's Name

Birth Date

Food Intolerances

Child 2:

Child's Name

Birth Date

Food Intolerances

Child 3:

Child's Name

Birth Date

Food Intolerances

Parent / Guardian Permission:

I hereby consent to participation by my son(s)/ daughter(s) in the Middle School Bible Study at St. Matthew during the 2025-2026 academic year. I understand that this program will take place on parish grounds and that my child(ren) will be under the supervision of authorized personnel.

Your Signature

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