College Street Baptist Church YOUTH Registration & Permission 2019-2020
YOUTH Groups meet on Sunday @ 5:00pm & Wednesday @ 6:00pm
Youth #1 Name *
First and Last Name
Your answer
Youth #1 Cell Number *
please enter "zero" if no cell number
Your answer
Youth #1 Email Address *
please answer "none" if no email address
Your answer
Youth #1 Birthday *
MM
/
DD
/
YYYY
Youth #1 Current Grade *
Youth #1 Please list any food allergies that your youth has: *
Your answer
Youth #1 Please list any allergies/concerns that your youth has: *
Your answer
Youth #2 Name
First and Last Name
Your answer
Youth #2 Cell Number
please enter "zero" if no cell number
Your answer
Youth #2 Email Address
please answer "none" if no email address
Your answer
Youth #2 Birthday
MM
/
DD
/
YYYY
Youth #2 Current Grade
Youth #2 Please list any food allergies that your youth has:
Your answer
Youth #2 Please list any allergies/concerns that your youth has:
Your answer
Youth #3 Name
First and Last Name
Your answer
Youth #3 Cell Number
please enter "zero" if no cell number
Your answer
Youth #3 Email Address
please answer "none" if no email address
Your answer
Youth #3 Birthday
MM
/
DD
/
YYYY
Youth #3 Current Grade
Youth #3 Please list any food allergies that your youth has:
Your answer
Youth #3 Please list any allergies/concerns that your youth has:
Your answer
Parent/Guardian Name *
First and Last Name
Your answer
Complete Address/Apartment # *
Street Address with Apartment #, City, SC
Your answer
Cell Phone # *
Your answer
Email Address *
Your answer
OK to Photo/Video Your Youth for Youth Ministry Related Purposes? *
Person(s) authorized to pick up your youth *
Your answer
In Case of Emergency Contact Name *
First and Last Name
Your answer
Emergency Contact Phone # *
Your answer
Parent/Guardian Signature *
Submitting this form will serve as parent/guardian signature that your child (children) can attend College Street Baptist Church YOUTH Program 2019-2020 year and permission to ride the church bus if applicable. Please type your First and Last Name
Your answer
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