United Christians Liberty Evangelical Youth Membership Registration Form
Church/Location
Example: Missouri UCLE Church or Missouri, US
Full Name
First Name, Last Name
Gender
Male/Female
Date of Birth
-
Month
-
Day
Year
Date
Street Address
City
State
Zipcode
Phone
Name of Church
Name of Church, City of Location
Name of Senior Pastor
PARENT/GUARDIAN INFORMATION
Parent(s)/Guardian(s) Name
Street Address
City
State
Zipcode
Phone
EDUCATION INFORMATION
Name of your School
Educational Level
Elementary School
Junior High School
High School
College
University
Vocational School
Other
Elementary School Grade Level (if applicable)
Junior High School Grade Level (if applicable)
High School Grade Level (if applicable)
College Year (if applicable)
University Year (if applicable)
Vocational School Year (if applicable)
MAJOR/JOB/PERSONAL GOALS & OBJECTIVES
Guardian/Parent Signature or Youth Signature IF over 18 years of age
Today's Date
-
Month
-
Day
Year
Date
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