Registration TEEN INFORMATIONSelect one* New Member Returning Member First Name* Last Name* Birth date* Grades (as at September)* 7th 8th 9th 10th 11th 12th Street Address* State* Zip Code* Cell Number* Would you like to receive updates via text?* Yes No Home Phone Teen E-mail PARENT/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:EmailThis field is for validation purposes and should be left unchanged.
