Youth Registration 2019
Please use this form to register your young person for Rite 13, J2A, or YAC.
When you register you will be added to the appropriate youth email list to receive ongoing updates about formation and service opportunities for youth at St. Cs.
Email address *
Email address *
Your answer
Young Person's First Name *
Your answer
Young Person's Last Name *
Your answer
What Grade is your young person entering? *
What School is your young person attending? *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Gender *
Young Person's Email *
Your answer
Young Person's Cell
Your answer
Parent/Guardian 1 First Name *
Your answer
Parent/Guardian 1 Last Name *
Your answer
Parent/Guardian 1 Email *
Your answer
Parent/Guardian 1 Cell Phone *
Your answer
Parent/Guardian 2 First Name *
Your answer
Parent/Guardian 2 Last Name *
Your answer
Parent/Guardian 2 Email *
Your answer
Parent/Guardian 2 Cell Phone *
Your answer
Are you new to St. Columba's? *
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Photo Consent
I understand that during church activities, there may be photographs taken of me or my child that may be used on the church website or in various St. Columba's publications (printed and online). By checking the "Yes" box below, I give St. Columba's Episcopal Church permission to photograph me/my child and use our pictures solely for the church’s publications, website or Facebook page. It is a policy of St. Columba's never to publish a child’s name on its website, or with any of its online publications. By checking "No," I understand that St. Columba's will to the best of its ability exclude me/my child from any pictures.
Photo Consent *
May we share contact information with other parents?
If you choose yes, you agree to publish basic contact information (parent and youth name; parent email and phone; youth email and phone will be excluded) to other members of the class to facilitate coordination and program support. Everyone who selects yes will have access to the contact sheet.
Share contact info? *
Notes
E.G. allergies; physical, developmental, or behavioral limitations.
Special Notes for leaders? *
Your answer
My child has permission to leave the St. C's campus with her/his class on occasion to go to Starbucks or similar destination with at least two adults. *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of St. Columba's Episcopal Church. Report Abuse - Terms of Service