SJB Youth Group Info 2018-19
Please fill this out (or update) at the start of each school year!
Student's Name *
Your answer
Name(s) of Parent(s) or Guardian(s) *
Your answer
Complete Mailing Address for Student *
Your answer
Mailing Address for Parents/Guardians (if different from student)
Your answer
Mother's Cell Phone
Your answer
Father's Cell Phone
Your answer
Student Cell Phone
Your answer
Do you give permission to receive texts from the Youth Group? *
If yes, who is your cell phone carrier?
Your answer
Parent/Guardian Email address *
Your answer
Student Email
Your answer
Name & Phone Number of Emergency Contact (in case parent/guardian cannot be reached) *
Your answer
Please list anyone who is restricted from picking up your student. *
Your answer
Student birthday *
MM
/
DD
/
YYYY
School student attends *
Your answer
Student's Grade for 2018-19 school year? *
Your answer
Student's T-shirt Size *
Student's Physician and Phone Number *
Your answer
Hospital Preference *
Your answer
Please list any chronic or existing medical issues. *
Your answer
List any instructions for care of the above. *
Your answer
List any medications your student is taking on a regular basis (include dosage) *
Your answer
Please list any allergies for your student. *
Your answer
Would you be interested in assisting with Youth Activities? *
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