STUDENT INFO

FIRST NAME

LAST NAME

LOCATION

GRADE

BIRTHDAY

Month

Day

Year

STUDENT EMAIL

STUDENT PHONE

PARENT/GUARDIAN INFO

NAME (First & Last)

PARENT/GUARDIAN EMAIL

PARENT/GUARDIAN PHONE

GENERAL INFO

Does your student have any diagnosed medical conditions or allergies that we need to be aware of?

Yes

No

Does your student have any learning or behavioral needs that we should be aware of?

Yes

No

Do you have a home church?

Yes

No

How did you hear about Arise?

Do you agree to the Participant Agreement below regarding photography and liability?

Yes

No

Arise Participant Agreement

Yes, I want email updates about Arise in my district.

By signing below, I (as Parent/Guardian) permit the student listed above to attend the Released Time Bible Education class of Trinity Church under the Program “Arise” according to Indiana Code 20-33-2-19

Parent/Guardian Signature

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By clicking "SUBMIT" you are agreeing that this form is correct and the signature above is of a legal parent/guardian - authorizing this student to leave school property during designated times to utilize transportation and programming provided by Arise.