Youth Registration

First and Last Name*

First and Last Name

Preferred Name*

Preferred Name

Date of Birth*

Date of Birth

Preferred Prounoun*

Preferred Prounoun

School Grade (2022/2023)*

School Grade (2022/2023)

Which school does participant attend? (2022/2023)*

Which school does participant attend? (2022/2023)

Participant Phone Number

Occasionally, our youth ministry staff will contact youth by text, with your number included on the text, to check in, share updates about programs, or ask to lunch, coffee, or tea. Do we have permission to text the youth's phone number?*

Occasionally, our youth ministry staff will contact youth by text, with your number included on the text, to check in, share updates about programs, or ask to lunch, coffee, or tea. Do we have permission to text the youth's phone number?

Yes
No

All are welcome. Does the youth participant have special needs we should know about, so that we can provide the safest and most comfortable environment possible?*

All are welcome. Does the youth participant have special needs we should know about, so that we can provide the safest and most comfortable environment possible?

Is there anything else you would like us to know about the participant?

Please list any allergies, dietary restrictions, or medical needs your child has.*

Please list any allergies, dietary restrictions, or medical needs your child has; if none, please write 'none'.

Step 1 of 3

Family Information

Parent 1

Parent 2