YoungLives NYCLI Club Registration

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ALL PREGNANT & PARENTING TEENS MOMS 20 & UNDER ARE WELCOMED.

Location TBA Time 12:30pm to 3pm

TODAS LAS MADRES ADOLESCENTES EMBARAZADAS Y PADRES MENORES DE 20 SON BIENVENIDAS.

Hora 12:30pm a 3pm

Name/Nombre *

Address/Dirección *

Phone Number/Número de teléfono *

Zip Code *

Email Address/Dirección de correo electrónico *

(MOMS)Date OF Birth/Fecha de nacimiento *

(MOMS) Childs Name, Gender and Age/Nombre, sexo y edad del niño *

Allergies of Volunteers, Mom & child/Alergias de mamá y niño *

For Volunteers Only (Not Moms)/Solo para voluntarios (no para mamás)

Serve Food, Set up & Clean up

Childcare

(Please be open to do childcare because thats the greatest need.)

Option 4

Clear selection

Who referred you? What the persons name? What agency or church are you from?

¿Quien lo refirió? ¿De qué agencia o iglesia eres?

Do you consent to your picture being taken at Younglives Events? *

Yes

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