18-19 Kirk Youth Group Info Form
For your safety, we ask that this form be filled out before participating in any off-campus youth activities. We would like to think that nothing bad would ever happen, but we also don't like to take risks! This information will NOT be shared and is only kept on record for the youth year (August-July each year). Please contact Pastor Jordan with any questions! jdavis@kirkofkildaire.org
Youth Name *
Your answer
Youth Birthday *
Your answer
Youth Grade *
Your answer
School (and if year-round, track) *
Your answer
Youth Phone
Your answer
Youth Email
Your answer
Parent 1 Name *
Your answer
Parent 1 Phone *
Your answer
Parent 1 Email *
Your answer
Parent 2 Name
Your answer
Parent 2 Phone
Your answer
Parent 2 Email
Your answer
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