Registration TEEN INFORMATIONSelect one*New MemberReturning MemberFirst Name*Last Name*Birth date*Grades (as at September)*7th8th9th10th11th12thStreet Address*State*Zip Code*Cell Number*Would you like to receive updates via text?*YesNoHome PhoneTeen E-mailPARENT/GUARDIAN INFORMATIONParent/Guardian #1 Full Name:*Parent/Guardian #1 Relationship to teen:*Parent/Guardian #1 Cell Phone:*Parent/Guardian #1 Home Phone:*Parent/Guardian #1 Email:*Parent/Guardian #2 Relationship to teen:Parent/Guardian #2 Home Phone:Parent/Guardian #2 Email:PARENTAL/GUARDIAN CONSENTThis portion should be completed by a parent/guardian.As a parent/guardian, I understand that promotional pictures (individual and group) will be taken during youth group meetings and youth group events. I give my permission for my child's picture to be used for church promotional materials only (website, social media, local news media) as determined by the youth ministry office. I also give consent for the youth ministry office to contact my child directly via phone, text, or email. (Please sign/type your name below with your consent).*Additional Comments:PhoneThis field is for validation purposes and should be left unchanged.
