Manhood Training Ministry 2010 - 2011 Online Registration

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Your Email:

A Password:

Student's First Name *

Student's M.I. / Nickname

Student's Last Name *

Street Address *

City *

State * please use 2 letter state abbreviation (DC, MD or VA)

5-Digit Zip Code *

Date of Birth (MM/DD/YYYY) * For Example, 12/25/1995

Home Area Code & Phone Number (example: 823-123-9876) *

Mobile Area Code & Phone Number (example: 823-123-9876) *

Email Address (example: maryjones@hotmail.com) We will use this email address to notify you of key updates and changes.

Parent / Guardian Information

First Name *

Middle Initial

Last Name *

Street Address *

City *

State * please use 2 letter state abbreviation (DC, MD or VA)

5-Digit Zip Code *

Home Area Code & Phone Number (example: 823-123-9876) *

Mobile Area Code & Phone Number (example: 823-123-9876) *

Email Address (example: maryjones@hotmail.com) We will use this email address to notify you of key updates and changes.

Health Questions

Does the young man have any physical or mental limitation that could affect his ability to participate in the MTM? * YesNo

If YES, please explain:

Is the young man on medication that he might need to receive during the MTM sessions? * YesNo

If YES, please explain:

A fundamental aspect of this ministry is teaching and demonstrating for the Young Men In Training the importance of being responsible in approaching their priorities. By your decision to place the young man in your family in this ministry, you are committing to make his punctual participation a priority. With this in mind, please detail the transportation plan for the young man in your family.

Virtually All Of Our Sessions Begin at 6:00 PM on Fridays at The Nineteenth Street Baptist Church.

Who will be responsible to for transporting the young man to the MTM sessions?

First Name *

Middle Initial

Last Name *

Street Address *

City *

State * please use 2 letter state abbreviation (DC, MD or VA)

5-Digit Zip Code *

Home Area Code & Phone Number (example: 823-123-9876) *

Mobile Area Code & Phone Number (example: 823-123-9876) *

Email Address (example: maryjones@hotmail.com) We will use this email address to notify you of key updates and changes.

Fun & Growth Information Please answer/complete the following based on your opinion – NOT the Young Man's

Favorite Fun Activities * (a favorite sport or outing, etc.)

Favorite School Subject(s): *

Most Recent Grade In Favorite Subject(s): *

Most Recent Grade in Least Favorite Subject(s):

Least Favorite School Subject(s): *

Most Admired Person(s):

Favorite Character(s) From The Bible:

If I could help him to get better at one thing, it would be: *

People are always praising him for/because: *

IMPORTANT INSTRUCTIONS Please use your browser to PRINT OUT 2 COPIES of this form.

Once you have completed the form, please hit the SUBMIT KEY at the bottom of this form.

After you hit submit, the system will give you an opportunity to PRINT your responses (at bottom of page). Please print two copies BEFORE coming to the Manhood Training Session this week, AND:

SIGN and DATE the form in the spaces provided
bring the this completed and signed copy of the fom to the Manhood Training Ministry session this Friday - we will keep it for our records

I certify that I am the custodial parent/legal guardian of the young man named on this form: