NEXUS CONNECT CARD

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NEXUS
Where: Park Chapel
1176 E. McKenzie Rd.
Greenfield IN 46140
When: Wednesdays during the school season
Time: 7:00 PM - 8:30 PM
(hangout from 6:30pm - 7pm)
What: Games, snacks and teaching
Questions: please email Kiefer at khoneycutt@parkchapel.org

Stay informed on PC3 Students Instagram
Receive Text Message Updates
Text @pc3jh to 81010 for Junior High

Connect Card information is a vital piece of communication for Park Chapel. Information is used for a variety of things including:

contact information
statistics
safety & security
follow-up
data records
volunteer strategies
programming decisions
and MUCH MORE

PERSONAL INFORMATION

Name

Address

Phone

Church home

Please select one option.

Park Chapel Other None

School District

Please select one option.

Eastern Hancock Greenfield-Central Home School Knightstown Mount Vernon Southern Hancock Rushville Other

Grade

Please select one option.

7th 8th

Are you involved in any extra curricular's? (sports, drama, etc...)

T-Shirt Size (adult)

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Small Medium Large X-Large XX-Large

FUN FACTS

Favorite Candy?

Favorite Drink?

Favorite Restaurant?

CONTACTING YOU

Which do you prefer?

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email text Instagram

FAMILY INFORMATION

Parent / Guardian Name(s)

Parent / Guardian Email

This address will receive a confirmation email

Parent / Guardian Phone

Emergency Contact Name

Emergency Contact Phone

Brothers | Sisters (names)

PHOTO/VIDEO RELEASE:

Please be aware that this event may be photographed. Your submission of this form and participation in the event grants Park Chapel permission to use your picture, silhouette or reproductions of your physical likeness and voice in any manner associated with promotion and/or celebration of church events.

NEXUS CONNECT CARD

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