Life Teen 2018-2019 Teen Contact Form
Welcome to Life Teen!
Teens, please fill out this form so we have emergency contact information for you and can put you in a small group according to your grade. All questions are required.
If the question does not apply or you do not know the answer, type in N/A. However, if you leave the contact information for a parent(s) incomplete, we will ask you to fill out the form again with complete answers. Thanks!
First name *
Your answer
Last name *
Your answer
Gender *
Graduation year *
Your email (if you have one) *
Your answer
Your cellphone (if you have one) *
Your answer
Birthday (month/day/year) *
MM
/
DD
/
YYYY
Father's first and last name *
Your answer
Mother's first and last name *
Your answer
Father's email *
Your answer
Mother's email *
Your answer
Father's cellphone *
Your answer
Mother's cellphone *
Your answer
I have read and agree to follow the Life Teen House Rules *
Required
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