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Student LifeGroup Sign-Up

We are glad that you would like to get connected with a LifeGroup! Please fill out the information below and someone will be in contact with you to get you connected! 

*First Name
*Last Name
Please list the one friend you would most desire to be in a LifeGroup with:
*Street Address
*City
*State
*Zip Code
*Gender
*Birthdate
*What school do you attend?
*Grade
Student Email Address
Student Cell Phone #
*Parent Name(s)
*Parent Cell #(s)
*Parent Email Address(es)