YOUTH CENSUS ( For youth ages 4 to 18)
For Youth ages 4 through 18. Please help us update our records by completing the form below. After you submit your information, it will be sent to Jacinta Warnie at
jacinta@saintsabina.org
.
Alternatively, you may download the PDF from the website and bring it to the church office or scan it and attach it to an email to Jacinta Warnie at
jacinta@saintsabina.org
.
* Required
YOUTH LAST NAME:
*
Your answer
YOUTH FIRST NAME:
*
Your answer
AGE
*
Your answer
BIRTHDAY:
*
MM
/
DD
/
YYYY
GENDER:
*
Male
Female
YOUTH EMAIL ADDRESS(ES)
Your answer
YOUTH FACEBOOK NAME:
Your answer
YOUTH INSTAGRAM ID:
Your answer
YOUTH MOBILE PHONE:
Your answer
LANDLINE PHONE:
Your answer
STREET ADDRESS:
*
Your answer
CITY
*
Your answer
STATE
*
Your answer
ZIP CODE
*
Your answer
PARENT'S MOBILE PHONE (S):
*
Please specify which number belongs to a Mom or to a Dad
Your answer
PARENT'S EMAIL (S):
*
Your answer
SCHOOL NAME:
*
Your answer
GRADE
*
Choose
Pre - Kindergarten
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th - High School Freshman
10th - High School Sophomore
11th - High School Junior
12th - High School Senior
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