Youth Group Registration and Contact Information

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Youth Group Registration and Contact Information

• Today's Date*
  MM slash DD slash YYYY
• Student's Name*
  First Last
• Student's Date of Birth (mm/dd/yyyy)*
  MM slash DD slash YYYY
• Address*
  Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Student's Phone Number*
• Student's Email
• Have you been a part of a church in the past?
• What kind of experience did you have there?
• What kind of experience do you hope to have with us?
• What school do you attend?
• What activities are you a part of?
• What are your summers like?
• Do you have any food allergies? Please list and explain any restrictions.
• Parent/Guardian Name*
  First Last
• Relationship*
• Contact Number*
• Parent/Guardian Email
• Do you have any questions for us?

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of this form if any important information listed above changes!