Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Youth 1 *

First Name

Last Name

Register this youth for (check all that apply):

Jr. High Sunday School

Sr. High Sunday School

7th/8th Grade Confirmation

9th Grade Confirmation

Emerge (9th-12th grade youth group)

Youth's Phone Number

(###)

###

####

Youth may be contacted via text and/or email about program updates

yes

no

Birthdate *

MM

DD

YYYY

Baptism Date

MM

DD

YYYY

Youth 2

First Name

Last Name

Register this youth for (check all that apply):

Jr. High Sunday School

Sr. High Sunday School

7th/8th Grade Confirmation

9th Grade Confirmation

Emerge (9th -12th grade Youth Group)

Youth's Phone Number

(###)

###

####

Youth may be contacted via text and/or email about program updates

yes

no

Birthdate

MM

DD

YYYY

Baptism Date

MM

DD

YYYY

Youth 3

First Name

Last Name

Register this youth for (check all that apply):

Jr. High Sunday School

Sr. High Sunday School

7th/8th Grade Confirmation

9th Grade Confirmation

Emerge (9th-12th grade youth group)

Youth's Phone Number

(###)

###

####

Youth may be contacted via text and/or email about program updates

yes

no

Birthdate

MM

DD

YYYY

Baptism Date

MM

DD

YYYY