Saint Helena Youth Group Registration Form

Saint Helena Youth Group Registration
Youth Name

First NameLast Name
Date of Birth

MonthDayYear
Date
School
Grade Level
Does the child have any allergies or medical conditions that we should be aware of?
Parent/Guardian Information
Name

First NameLast 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

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Date Signed

MonthDayYear
Date
Should be Empty:

Saint Helena Youth Group Registration