Youth Group Contact Information

Your Name

Address

Phone

This address will receive a confirmation email

Grade?

6th 7th 8th 9th 10th 11th 12th

Birthdate

Gender

Male Female

Please List below your parent/guardians full names, address(es), email(s), and cell phone(s)

Of the names listed above, who should we send your consent and emergency authorization forms to?

Description

Thank you for helping us update our records!

If you have any questions, please contact Amy Hammel in the Church Office – amy.hammel@northstarperry.org

Youth Group Contact Information

Description

Please Fix the Following