Welcome to the start of a new year of Youth Group!
Youth Participant Information
First Name
*
Last Name
*
School Grade
-- None --
Nursery (birth - 3.5 years)
Preschool (3.5 yrs - 5 yrs)
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
6
7
8
9
10
11
12
Date of Birth
School Name
Cell Phone Number
E-mail
Preffered Method of Communication
Cell Phone
E-Mail
Other : Please Provide Below
Other:
Favorite Candy Bar
Parent/Guardian Information
Parent/Guardian Name (First & Last Name)
This information needs to be provided once per family. If you have already provided this information for another child check this box.
Yes, I have already provided this information.
Email Address
*
Church Affiliation
Crossbridge Community Church
Evangelical UMC
Trinity United Methodist
Other
None
Other Church Affiliation: Please list
Mailing Address
Mailing City
Mailing Zip Code
Primary Phone Number
Alternate Phone Number
Important Additional Information
Does your child have Allergies?
Does child have special needs? If yes, explain.
Comments
Emergency Contact Information
Emergency Contact Name
*
Relationship To The Child
*
Emergency Phone
*
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