Saint Helena Youth Group Registration
Youth Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
School
Grade Level
Does the child have any allergies or medical conditions that we should be aware of?
Parent/Guardian Information
Name
First Name
Last Name
Parent Phone Number
Please enter a valid phone number.
Parent E-Mail
example@example.com
Relationship
Acknowledgment
I allow my child to be photographed or be part of the video that will be used for marketing, promotion, and advertisements.
I allow my child to ride any vehicle that is related to the group's activities provided that there's an adult on board.
Parent/Guardian Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: