Youth Registration Form
Email address *
Youth Name *
Your answer
Date of Birth *
Your answer
Grade (September 2018) *
Parent Name *
Your answer
Parent Name
Your answer
Parent E-Mail *
Your answer
Parent E-Mail
Your answer
Parent Cell Phone *
Your answer
Mailing Address *
Your answer
Allergies/Disabiliites/Concerns
Below please list any allergies, disabilities or other information that you feel we should know about your child to enhance their experience:
Your answer
Program Support
What would you like to do as a parent to support the work of St. Luke’s Youth Ministries:
Your answer
Program Partipation *
Which events will your child participate in?
Required
Parental Signature *
By clicking "Yes" below, I am allowing my child to participate in programs at St. Luke's and I acknowledge that images of my child may be used in church publications and on the internet for non-commercial purposes without identifying my child by name.
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