Youth Group Registration 2021-2022

Youth Group Registration 2021-2022

Please fill out one form per teen.
Youth Name

First Name Last Name
Age
Date of Birth

Month Day Year
Date
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
School
Grade Level
Does the child have any allergies?
Does the child have any medical conditions that we should be aware of?
Do you want to be a volunteer church school teachers assistant?

YES NO Contact me with additional information
Parent/Guardian Information
Name

First Name Last Name
Cell phone number
Please enter a valid phone number.
Relationship
Photo Release
Wilton Presbyterian Church, St. Matthews Episcopal Church and WEPCO have my permission to use my or my child's photograph publicly to promote their ministry. I understand that the images may be used in print publications, online publications, presentations, websites and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
Parent/Guardian Signature

Clear
Date Signed

Month Day Year
Date
Should be Empty:

Parent/Guardian Information