Youth Student Registration 2019 - 2020 (6th - 12th grade)
Student's Name/Nickname/Preferred Name *
Birth Date - including birth year. *
MM
/
DD
/
YYYY
Age *
Grade and Name of School This Fall
Student email
Student cell #
Do you text? y/n
Clear selection
What is the best way to get in touch with you?
Mailing Address - including city and zip
Tell us about you! What are your special gifts, talents, or interests?
Parent/Guardian #1 Name and email *
Parent/Guardian #1 phone - please indicate if home or cell. *
Parent/Guardian #2 Name and email
Parent/Guardian #2 home phone - please indicate if home or cell.
From time to time, we will need parent chaperones for outings or special events. Would you be able to help out?
Clear selection
Would you be available to help out in Sunday School and Youth Group as an adult leader? (NOTE: If you have a child in CRASH!, we would ask you to help out with our eMERGE Youth – and vice-versa.
Clear selection
I give permission and consent for photographs or video footage of my student to be published and used by St Francis Church to illustrate and promote St. Francis Church and/or its ministries. For the safety and security of your student, we will never print your student’s name with his/her photo or video. *
Clear selection
What special activities for Crash and/or eMERGE are of interest to you (Youth)? *
Required
Other Activities
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