Student Registration Form

This is to help us get to know our students every student should have this filled out!

Your name *

Email address *

Birthday *

Phone number *

Address *

Gender *

School *

Grade *

Is this your first time coming to our Youth Group?

We want to make sure we get to know you better :D

Emergency Contact Person *

Please list an individual and their phone number to contact in case of an emergency.

Household members

Medical note (allergies, medications, etc.)

Do you want to be added to the email list? If yes, please put down any email addresses that should be added.

Pastor Dave corresponds regularly via email, please indicate if you and/or anyone else wish to be added.

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