Youth Group Registration Form

Registration Form

Fellowship Chapel Youth Group | Wednesday Evenings
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Name of parents/guardians*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone number*
Format: (000) 000-0000.
E-mail address*
example@example.com
Emergency contact*
Allergies/Medical Conditions
Additional Approved Pick Up
YesNo
YesNo
If yes, name of insurer:
Policy or Group number
I give Fellowship Chapel permission to use my child’s picture for slide shows for youth group events and celebrations and in Sunday Adult Worship Services.I give Fellowship Chapel permission to use my child’s picture on the Fellowship Chapel website and Social Media pages.I DO NOT give Fellowship Chapel permission to take photographs of my child.
Participation Agreement. By check box acknowledge and agree to the following statement:*
Printed name (Guardian)*

First NameLast Name
Signature*

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