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?0 of 50 max charactersWhat kind of experience did you have there?0 of 250 max charactersWhat kind of experience do you hope to have with us?0 of 500 max charactersWhat school do you attend?0 of 100 max charactersWhat activities are you a part of?0 of 200 max charactersWhat are your summers like?0 of 200 max charactersDo 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!
