Youth Registration Form

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Youth Name *

Date of Birth *

Grade (September 2018) *

Parent Name *

Parent Name

Parent E-Mail *

Parent E-Mail

Parent Cell Phone *

Mailing Address *

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:

Program Support

What would you like to do as a parent to support the work of St. Luke’s Youth Ministries:

Program Partipation *

Which events will your child participate in?

Church School

Junior Choir

Special Events

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.

Yes

Submit

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