Registration Form For Youth Activities

Check All Activities That Apply (required)
Nursery CareYouth GroupAwanaRockVBS

Child's Name (required)

Date Of Birth (required)

Grade (required)

Father's Name (required)

Mother's Name (required)

Address (required)

City, State, Zip Code (required)

Telephone (required)

Your Email (required)

Emergency Contact Number (required)

List Any Allergies Your Child Has

Does Your Child Receive Special Education?

Let Us Know Any Other Pertinent Information

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Disclaimer: Occasionally church members, their families or friends, and the media will photograph and/or video tape church activities (ex. dramas, picnics, etc.) for their own use or for church promotion. Your child may be photographed or recorded. These videos or photos may be used on our web site or social media.