Our 125th Anniversary Ornament is available for purchase through the "Donate Now" button via Square.

Registration

TEEN INFORMATION
Select 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 INFORMATION
Parent/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 CONSENT
This 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:
Phone
This field is for validation purposes and should be left unchanged.