Remnant Teens - Information Sheet
Teen's Full Name
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Teen's preferred name
Your answer
Birthday
MM
/
DD
/
YYYY
Mailing Address
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Home Address (if different from mailing)
Your answer
Parent's Phone Number *
Your answer
Teen's Phone Number
Your answer
E-mail
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With whom does the teen live? (parents, guardians, etc. please provide name and relationship to teen)
Your answer
List of Siblings (please include ages)
Your answer
School Teen Attends and Current Grade
Your answer
List of any allergies
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In case of accidental exposure to allergies, what steps should be taken?
Your answer
List any medical information that your teen's leader(s) should know?
Your answer
Is there anyone that should not pick up your teen?
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Are there any custody agreements of which the leaders should be aware?
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In the case of an emergency and a parent/legal guardian cannot be reached, whom should we contact? (Please list the name, phone number and relationship to teen of two emergency contacts) *
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Special Instructions or Information
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