Parent Notification Request 
Help us stay connected with you about Middle School Ministry by providing us contact information. If your child resides in more than one household, please fill out one form for each household you wish to receive information. 
* Information is required in all the fields.  Please enter N/A if the information is not applicable.

Parent 1: Information
First Name:
 *
Last Name:
 *
Email Address:
 *
Phone (primary):
 *
Phone (alternate):
 *
Parent 2: Information
First Name (2):
 *
Last Name (2):
 *
Email Address (2):
 *
Phone (primary)(2):
 *
Phone (alternate)(2):
 *
Mailing Address
Address:
 *
City:
 *
Zip Code:
 *
 
Child 1: Information
Child's First Name:
 *
Child's Last Name:
 *
Child's Email address:
 *
Current Grade:
Graduation Year
Gender:
Birthday (mm/dd/yyyy):
 *
Child 2: Information:
Child's First Name(2):
Child's Last Name(2):
Child's Email Address(2):
Current Grade (2):
Graduation Year (2):
Gender(2):
Birthday (mm/dd/yy)(2):
Do not enter anything in this field:

* indicates a required field
 

    JAM is a Student Ministry of Westlake Hills Presbyterian Church
    7127 Bee Caves Rd.  |  Austin, TX 78746   |   PH: PH: 512.327.1116  l  FAX: 512.328.4238