My Life Matters Registration for Christian Enrichment Clubs at School and the Warehouse Youth Center
Registration for Elementary, Middle, and High School Students attending My Life Matters clubs and the Warehouse Youth Center.
Level
Club Site
Required
First Name (Student's)
Your answer
Last Name (Student's)
Your answer
School
Your answer
Age (Student's)
Your answer
Grade this Fall (Student's)
Small Group (Office Use Only)
Your answer
Gender (Student's)
Birthdate
Your answer
T-Shirt Size
Student's Local Church (If applicable)
Your answer
Parent/Guardian Name
Your answer
Phone (Parent/Guardian)
Your answer
Email (Parent/Guardian)
Your answer
2nd Phone (Parent/Guardian or Student)
Your answer
Extra Contact Person #1 - Name and Phone
Your answer
Extra Contact Person #2 (Optional) - Name and Phone
Your answer
Extra Contact Person #3 (Optional) - Name and Phone
Your answer
Student's Address
Your answer
Mailing Zip Code
Allergies
Your answer
Medications and Health Notes
Your answer
(optional) Counseling Permission
(optional) Middle School Shuttle
(optional) High School Shuttle
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