RESURGENT YOUTH

Our youth meetings are after worship on the 2nd and 4th Sundays of each month.

STUDENT REGISTRATION

Please complete the form below for each student in your household. (Eligible from grades 6th – 12th)

Receiving this information will allow us to better serve you and your family!

Please complete the form below for each student in your household. (Eligible from grades 6th – 12th)

Receiving this information will allow us to better serve you and your family!

Student First Name *

Student Last Name *

Student Phone *

Student Email *

Student Age *

Student Birthday *

Student's School *

Student Grade *

Does he/she have any food allergies or medical conditions we should be aware of?

Any other important information you would like us to know?

Are the student's parents married? *

Home Address *

Address Line 1

City

State / Province / Region

Zip / Postal Code

Country

Parent First Name *

Parent Last Name *

Parent Phone *

Parent Email *

Secondary Parent First Name

If inapplicable, leave spaces for secondary contact blank.

Parent Last Name

Parent Phone

Parent Email

Phone

GENERATIONS PASTORS

YOUTH LEADER

YOUTH LEADER