Youth Group Registration and Contact Information Please submit a new copy 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? Δ of this form if any important information listed above changes!