Bethlehem A.D. Youth Registration 2018
For anyone under 17. Must be completed by parent/legal guardian,
Youth First Name *
Your answer
Youth Last Name *
Your answer
Youth/Child Age *
Your answer
Parent/Legal Guardian First Name *
Your answer
Parent/Legal Guardian Last Name *
Your answer
Youth Primary Phone
Your answer
Parent/Legal Guardian Primary Phone *
Your answer
Youth Email
Your answer
Parent/Legal Guardian Email *
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Church Affiliation (if any)
Your answer
What role would you like?
What night will you be with us?
For costuming purposes, please participate at least two of the three nights
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