Light It Up Youth Ministry Registration Form
Child's Name
First Name
Last Name
Child's name
First Name
Last Name
Child's Name
First Name
Last Name
Parent/ Guardian Name
First Name
Last Name
Parent/Guardian Name
First Name
Last Name
Parent/Guardian email
example@example.com
Child's email address ( for kids 13 and up only)
example@example.com
Parent/Guardian phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Child's phone number ( if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Do we have permission to take a picture of your child and post it on our newsletter?
Yes
No
Choose your child's age
2yrs old - 6yrs old
7yrs old - 12yrs old
13yrs old - 15yrs old
16 yrs old - 18 yrs old
Are you a member of New Life Temple Church ?
Yes
No
Are you a 1st time visitor ?
Yes
No
Please list any hobbies or extracurricular activities your child participates in.
Does your Child have any allergies ? Please list below ( please include any medication they are taking as well)
Do we have permission to take you child on field trips?
NO
Yes
If you selected yes we can take your child on a field trip please include an emergency contact (other than yourself ) List the name and number of the person.
Submit
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