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Youth Ministry
with Jun Ilagan
1st & 3rd Sunday Evenings|
5:30PM-7PM
Questions? Contact Jun Ilagan at 916-571-2166
Child's Name
*
First Name
Last Name
Where do you go attend..?
School
Church
Grade
Please Select
8th
9th
10th
11th
12th
Father's Name
*
First Name
Last Name
Mother's Name
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Emergency Contact:
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Consent Form
I consent that my child's photo may be taken during programming events at PBVM and that they may be used in the bulletin or on the website.
*
Yes, I agree
Signature
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