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Teen Church
This form will collect pertinent information for each youth participating in Teen Church (Ages 12-18) at Victory Grace Center. Please complete this form by providing the information requested so that we may serve you better.
Email address *
Email address *
Your answer
Teen's Name *
Your answer
Teen's Birthday
MM DD YYYY

/ / 2019
Parent/Guardian Name #1 *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Cell Number *
Your answer
Parent/Guardian Cell Name #2 *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Cell Number *
Your answer
If I am unable to retrieve my child directly after church, I give my teen permission to depart Teen Church with another adult/family member. *
If yes, please list the person(s) your teen may depart with below. PLEASE BE SPECIFIC.
Your answer
Allergies/Medications/Pertinent Information *
Your answer
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