PUCC Youth & Family Ministry Registration
Plymouth UCC Youth & Family Ministry welcomes you! We're excited to get to know your family!
Child's Name (1) *
Child (1) DOB *
MM
/
DD
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YYYY
Child (1) Baptized
Child's Name (2)
Child (2) DOB
MM
/
DD
/
YYYY
Child (2) Baptized
Child's Name (3)
Child (3) DOB
MM
/
DD
/
YYYY
Child (3) Baptized
Child's Name (4)
Child (4) DOB
MM
/
DD
/
YYYY
Child (4) Baptized
Parents or Guardian's Name(s) *
Email *
2nd Email (2)
Address *
Preferred Phone Number(s) *
Allergies and dietary restrictions *
PHOTO RELEASE *
Required
Is there anything else about your child/children that you'd like to share with us?
Submit
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