Power of Choice Mentoring - Student Sign-up Form

Youth Ministry Registration Form

Fill out the form carefully for registration of event
"Empowering teens to make informed choices as they journey into adulthood."
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender*
Male or Female
Student's Mobile Number*
Format: (000) 000-0000.
Parent/Guardian*

First NameMiddle NameLast Name
Address

Street Address

Apartment/Suite #

CityState

Postal / Zip Code
Parent/Guardian Phone Number*
Format: (000) 000-0000.
Email*

Confirmation Emailconfirm e-mail address
Saturday March 30th, 2024
Any Allergies or Medical Condition we need to be aware of?
Also by clicking submit, you do understand that we will send you a text from time to time regarding our program start dates, times, guest speakers etc.

You can always opt-out by texting STOP after receiving the texts.
Should be Empty:

Youth Ministry Registration Form