Middle School Youth Group Registration Form
Please note the information on this form is for the use of Blessed Hope Community Church and is not available for other individuals and groups. We will not disclose your email address, cell number or any other details without your permission.
Email address *
Student Information:
Name: *
Your answer
Date of Birth: *
Your answer
Gender: *
Home Address: *
Your answer
Students Phone #: *
Your answer
Are there any medical conditions that we should be aware of ? {food allergies, asthma, diabetes etc}
Your answer
Any additional information you would like us to know about your child?
Your answer
Parent Information:
In the event of an emergency relating to your son/daughter please provide information below in which we can contact you.
Name: *
Your answer
Phone: *
Your answer
Name:
Your answer
Phone:
Your answer
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