Youth Ministry Registration

"*" indicates required fields

Student Name*
MM slash DD slash YYYY
Please enter a number less than or equal to 18.
Household Mailing Address*
Parent 1 Name*
Parent 2 Name
Who Should Receive Youth Text Alerts?*
Authorized people to pick up my student (must be 18 years of age or older):*
Please add one per line, click + to add additional line
By signing below, I certify all information is true and correct to the best of my knowledge.
MM slash DD slash YYYY