The Summit Registration | Pathfinder Church

The Summit Registration Form

Please fill in your information below to complete registration.

Student Information
Student Name*
First Last
Student Birthdate*
MM
DD
YYYY
Gender*
Student Address*
Street Address Address Line 2 City ZIP Code
Student Main/Home Phone*
Student Cell Phone
Cell Phone Carrier (ie. Verizon)
Student Email
Grade*
- 9th
- 10th
- 11th
- 12th
Name of School*
Allergies and/or Special Needs
Is there anything we should know about your child that will enable us to better serve your child? If so, please describe them above or call to discuss.
How did you hear about The Summit?*
Parent One Information
Parent 1 Name*
First Last
Parent 1 Address*
Street Address Address Line 2 City ZIP Code
Parents 1 Main Phone*
Parent 1 Cell Phone*
Parent 1 Email*
Parent 2 Information
Parent 2 Name
First Last
Parent 2 Address
Street Address Address Line 2 City ZIP Code
Parent 2 Main Phone
Parent 2 Cell Phone
Parent 2 Email
Friend Request For Small Group Assignment
Students, please enter a friend or mentor request below. If possible, we will place you with students from your school if you do not have a request.
Friend Request
First Last
Mentor Request
First Last
Freshman/Sophomore Female Leaders: Alice Patton, Katie Lorenz, Allie Antle --- Freshman/Sophomore Male Leaders: Steve Patton, Jon Dunn, Eric Breyer --- Junior/Senior Female Leaders: Kelly Shepherd, Denyse Bozzay, Katie Pomp --- Junior/Senior Male Leaders: Cool John Solter, Jon Shepherd
Parent Permission
The registrant has my permission to participate in Pathfinder Student Ministry programs and related activities, to include the Sunday evening high school program, The Summit. I understand that when participating in Pathfinder Student Ministry activities, the registrant may be photographed for print, video, or electronic imaging. I understand the images may be used in promotional materials for Pathfinder Church. I acknowledge the images will be the sole property of Pathfinder Church.
Click below to accept*
- I accept

The Summit Registration Form

Student Information

Parent One Information

Parent 2 Information

Friend Request For Small Group Assignment

Parent Permission