ICB Youth Group Registration - 2017/18
All Youth Group Members must provide all required information on a yearly basis.

This form is to be filled by, or on behalf of prospective members of the Youth Group. It is not a substitute for the Annual ICB Family Membership enrollment which parents must complete separately. Youth Group participation does not confer ICB General Body membership privileges to parents.

Incomplete or incorrect registration information may affect participation and voting privileges with respect to Youth Group activities and election until corrections are made, and accepted.

First Name *
Your answer
Last Name *
Your answer
E-mail Address *
Your answer
Phone number
Your answer
Birthday *
MM
/
DD
/
YYYY
Father's Name *
Your answer
Father's Phone Number *
Your answer
Father's E-mail *
Your answer
Mother's Name *
Your answer
Mother's Phone Number *
Your answer
Mother's E-mail *
Your answer
Are parents members of ICB Wayland? *
Do you attend Sunday School at ICB Wayland? *
Home Address (Street Address, State, Zip Code) *
Your answer
School Grade (not Sunday School) *
School Name *
Your answer
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