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Youth Information Sheet

Youth Information Sheet

Student's Personal Information

Name of Student
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Birthdate
Grade
School
Who invited you to Youth Group?

Student's Contact Information

Home Phone
Student's Cell Phone
May we send you text updates?
YesNo
Student's Email
May we send you weekly email updates?
YesNo

Parents' Information

Father or Guardian's Name
Mother or Guardian's Name
Parent's Cell Phone
May we send you text message updates?
YesNo
Parent's Email
May we send you email updates?
YesNo

Verification

Please enter any two digits *Example: 12
This box is for spam protection - <strong>please leave it blank</strong>: