Youth Ministry Registration

Thank you for signing up for using the virtual check in system. This will help to improve effeciency for the sign-in process. We need a seperate form filled out for each of teenagers. Once this is completed our team can check you in by touching on a secure app.

In the future, we will have kiosks available for you to be able to quickly check in as you enter the building.

Youth Information

Name

Date of Birth

Grade

Profile Photo

Upload (8MB)

Please tell us about any learning, developmental disabilities, special needs so we can better support your student:

List allergies and medical diagnosis that is important for us to be aware of:

Parent/Guardian Information

Primary Name

Relationship to Youth

Primary Email

This address will receive a confirmation email

Primary Phone

Home Address

Secondary Contact Name:

Relationship to Child

Secondary Contact Phone

Emergency Contact

Emergency Contact Name

Relationship to Student

Emergency Contact Phone

Consent & Acknowledgments

Date Registration Submitted

Description

Please fill out this student registration form and click submit.

Youth Ministry Registration

Description

Please Fix the Following