YIPC Youth Group Registration 2018
Please complete this form in full. For multiple children, please complete a separate form for each child.
Child's first name:
Your answer
Child's last name:
Your answer
Child's DOB:
MM
/
DD
/
YYYY
Child's current school grade:
Your answer
School attending:
Your answer
Any allergies or health conditions that would be important for us to know:
Your answer
Parents' names:
Your answer
Best email address for communication:
Your answer
Cell phone for emergency contact:
Your answer
Additional cell/ emergency number:
Your answer
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