Youth Cafe Registration

Registration Form

August 13th! Youth Cafe is on the second Thursday of the month, at 5:15pm. 306 Bradley Street Suite B. Carrollton, GA 30117 Our CPS-Y leader is Ms. Alexis Lanning. Youth between 13 to 17 are recommended to participate on this.
Full Name - First Name and Last name of YOUTH

Primer nombre del JovenApellido del joven
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
I Parent/Guardian , parent of Youth name give permission to participate in Youth Community Conversation. I understand that I will be responsible for my son/daughter's transportation. In case of emergency, please contact me at Area Code Phone Number .
Signature
What topics matter to you
Should be Empty:

Registration Form