We would love to have you join the Mettle Room Ministry! Please fill out the form below and we will contact you with more details. Please enable JavaScript in your browser to complete this form.Date / Time *DateTimeStudent Name *FirstLastMembership Level *K-6 Student, 5 Full Days a weekK-6 Student, 3 Full Days a weekK-6 Student, 5 Half Days a weekK-6 Student, 3 Half Days a week7-12 Student, 5 Full Days a week7-12 Student, 3 Full Days a week7-12 Student, 5 Half Days a week7-12 Student, 3 Half Days a weekHalf Days?MondayTuesdayWednesdayThursdayFridayPlease indicate which days your student will attend.Half Days? TimeMorningAfternoonPlease indicate whether your student will attend morning or afternoon.Grade Level *123456789101112Student PhoneStudent EmailSTUDENT #2Student NameFirstLastMembership LevelK-6 Student, 5 Full Days a weekK-6 Student, 3 Full Days a weekK-6 Student, 5 Half Days a weekK-6 Student, 3 Half Days a week7-12 Student, 5 Full Days a week7-12 Student, 3 Full Days a week7-12 Student, 5 Half Days a week7-12 Student, 3 Half Days a weekHalf Days?MondayTuesdayWednesdayThursdayFridayPlease indicate which days your student will attend.Half Days? TimeMorningAfternoonPlease indicate whether your student will attend morning or afternoon.Grade LevelK123456789101112Student PhoneStudent EmailSTUDENT #3Student NameFirstLastMembership LevelK-6 Student, 5 Full Days a weekK-6 Student, 3 Full Days a weekK-6 Student, 5 Half Days a weekK-6 Student, 3 Half Days a week7-12 Student, 5 Full Days a week7-12 Student, 3 Full Days a week7-12 Student, 5 Half Days a week7-12 Student, 3 Half Days a weekHalf Days?MondayTuesdayWednesdayThursdayFridayPlease indicate which days your student will attend.Half Days? TimeMorningAfternoonPlease indicate whether your student will attend morning or afternoon.Grade LevelK123456789101112Student PhoneStudent EmailADDRESSAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMEDICALAllergies/Information *List any allergies or information the Mettle Room staff needs to know. If multiple students, please list student name along with information. If none, list "N/A."I give The Mettle Room permission to treat my child with basic first aid if medically necessary. *YesNoPARENT/GUARDIAN1. Parent Name *FirstLast1. Parent Phone *1. Parent Email *Check if Address Same as StudentSame Address as Student1. Parent AddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePARENT/GUARDIAN2. Parent NameFirstLast2. Parent Phone2. Parent EmailCheck if Address Same as StudentSame Address as Student2. Parent AddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEMERGENCY INFORMATION1. Emergency Contact Name *FirstLast1. Emergency Contact Phone *2. Emergency Contact NameFirstLast2. Emergency Contact PhoneALTERNATE PICK UP PERSONAlternate Pick-up PersonFirstLastHow did you find out about The Mettle Room?MEMBERSHIP APPLICATION *I have read and understand the Membership Application with 'the Mettle Room Ministry.' Name *FirstLastBy checking the Membership Application box above and typing my name, this will be considered the same as signing the Membership Application.Submit MEMBERSHIP APPLICATION MONTHLY FEES Basic First Aid Info
