Youth Empowerment
Have you already registered your child/ren?
*
Yes
No
Back
Next
Save
Youth Empowerment
Registration Form
Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Age
Grade in School
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Gender
Male
Female
Back
Next
Save
Parent/Guardian Information
Parent/ Guardian Full Name
First Name
Last Name
Relationship to Youth
Primary Phone Number
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Save
Emergency Contact
Full Name
Phone Number
Please enter a valid phone number.
Relationship to Youth
Back
Next
Save
Church Involvement
Is your child a member of this church?
Yes
No
If no, what church do you attend?
Which ministries is your child interested in?
Angels Of Praise
A Chosen Generation
Men Of Standard
Youth Hospitality
Media Team
Back
Next
Save
Medical Information
Does your child have any allergies or medical conditions?
Is your child currently taking any medications?
Back
Next
Save
Permissions
Photo/Video Permission: I give permission for my child to be photographed or recorded for church activities.
Yes
No
Medical Consent: I authorize emergency medical care if necessary.
Yes
No
Parent/ Guardian Signature
Today's Date
-
Month
-
Day
Year
Date
Back
Next
Save
Need to Sign In
If yes, click the next button. If no, click the submit button
Do you need to sign in your child/ren?
Yes
No
Back
Save
Submit
Next
Sign In/ Sign Out
Child/ren Name(s)
Sign In
Sign Out
Signature
Save
Submit
Should be Empty: