Youth Group Registration

Youth Group Registration
Please register your child/ren each school year.

One form per child.
Youth's Name:*

First NameLast Name
Birthdate:*

MonthDayYear
Gender:*

MaleFemale
School Grade (Fall 2023):*
Name of School:*
Allergies, medical concerns, special care or circumstances we should be aware of:
Parent's Name:*

First NameLast Name
Parent's E-mail*
Parent's Phone Number*
Student Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
By allowing your child to participate, parents/guardians agree that their child's image may be used on social media or church publications with no identilfying information.
Should be Empty: