Youth Group Registration

Grades 9-12

Please sign up here so that the youth can continue their formation as Christians, disciples of Jesus, by working with each other to deepen their knowledge and understanding, grow in wisdom, and in relationhsip with God and with each other.

Family Information

Father

First Name

Middle Name

Last Name

Mother

First Name*

Middle Name

Last Name*

Home Address

Street 1*

Street 2

City*

State*

Zip*

Parents' Phone

Required* --

Youth Information

Name

First Name*

Middle Name

Last Name*

E-mail

Required*

Date of Birth

Required* //

Grade in Public School
Required*

	9
	10
	11
	12

Gender
Required*

	Male
	Female