A.C.T.S. YOUTH MINISTRY PROGRAM REGISTRATION
Use this form to register for our Friday Night Program.
Email address *
CHILD'S LAST NAME / APELLIDO DE SU HIJO/A *
Your answer
CHILD'S FIRST NAME / PRIMER NOMBRE DE SU HIJO/A *
Your answer
HOME PHONE / TELE DE CASA
Your answer
CHILD'S CELL PHONE / CELL DE NIÑO/A
Your answer
CHILD'S EMAIL/ CORREO ELETRONICO DE NIÑO/A
Your answer
CHILD'S SCHOOL / ESCUELA DE NIÑO/A *
Your answer
CHILD'S CURRENT GRADE /GRADO DE NIÑO/A *
Your answer
DATE OF BIRTH / FECHA DE NACIMIENTO *
MM
/
DD
/
YYYY
T-Shirt Size (all sizes are adult) *
ADDRESS / DOMICILIO *
Your answer
FATHER'S LAST NAME / APELLIDO DE PAPA
Your answer
FATHER'S FIRST NAME / PRIMER NOMBRE DE PAPA *
Your answer
FATHER'S CELL PHONE/ NUMERO CEL DE PAPA
Your answer
MOTHER'S LAST NAME / APELLIDO DE MAMA
Your answer
MOTHER'S FIRST NAME/ PRIMER NOMBRE DE MAMA
Your answer
MOTHER'S CELL PHONE/ NUMERO CEL DE MAMA
Your answer
MOTHER'S EMAIL / CORREO ELETRONICO DE MAMA
Your answer
EMERGENCY CONTACT / CONTACTO DE EMERGENCIA *
Your answer
EMERGENCY CONTACT PHONE / TELEFONO *
Your answer
AGREEMENT *
Required
PERMISSION *
Required
PHOTO RELEASE *
Required
WHAT PARISH IS YOUR FAMILY REGISTERED TO? *
A copy of your responses will be emailed to the address you provided.
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