Contact information
LAC Youth Registration form if you have any question contact us to
Email address *
Student Name *
Email *
Address *
Grade *
Phone number *
Name *
Cellphone number *
Parent Email *
Emergency Contact. Name, Phone Number, Relationship to the Teen *
All LAC Youth are expected to:
* Be Responsible for their Guest
* Remain with the group at all time
* Be respectful to all attendence

My Parent and I Understand the guidelines above and realize, if violetd, actions deemed necessary by the youth Leader will be taken wich may include parental contact
Parent and Teen Name *
Photograpgy / Videography Waiver I Understan that my child may be photographed or recorded on video during the corse of youth ministry events. By The initialing Below I provide consent for their image to be used in either print, electronic, or video form for the promotional purpose of fututre retreats and youth group activities.
Clear selection
A copy of your responses will be emailed to the address you provided.
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