Fjeldberg Lutheran Church
2019-2020 Youth Group Registration Form
Email address *
First and Last Name of Student *
Your answer
Street Address, City, State & Zip *
Your answer
Phone number of Student (if applicable)
Your answer
Entering Grade in Fall 2019 *
Your answer
Parent(s) or Guardian(s) Name and Phone number. *
Your answer
Medical conditions/Allergies of student
Your answer
Is your child available to participate in Youth Group regularly? *
Please be advised that your child may be photographed at various Fjeldberg Lutheran Church events. Check all that apply. *
Required
Electronic Signature: (Type name of person filling out this form) *
Your answer
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