Registration for FUEL, DIG, Confirmation, Mailing List

Student Information

Student's Name (First & Last)

Parent's Name(s)

Street Address

City, State

Home Phone Number

Student Cell Phone Number

              Can we text you?  Yes      No

Mother's Cell Phone Number

              Can we text you?  Yes      No

Father's Cell Phone Number

              Can we text you?  Yes      No

Student's Email

Mother's Email

Father's Email

School

Grade

Birthday (MM/DD/YYYY)

Notes:

Program Registration

Please register my student for each below (check all that apply):

FUEL: Middle School

FUEL: High School

DIG: Middle School

DIG: High School

Confirmation: 1st Year (8th Grade)

Confirmation: 2nd Year (9th Grade)

General Mailing List