Straight Up Youth Registration Form
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Age
*
Grade
*
School District
I would like my child to participate in the following:
*
Praise Dance/Mime Ministry
Jesus Crew
Monthly Youth Missions
Outreach Opportunities
Mentoring Program (The Bridge)
Known Allergies
*
Parent's Info
Parent's Name
*
Last Name
First Name
Parent's Name
Last Name
First Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Signature
Submit
Should be Empty: