Youth Registration Form

St. James by-the-Sea Episcopal Church - 2016 Youth Registration Form

Youth's Name *

First

Last

Birth Date *

Current Grade in School *

School Attending *

Youth's Email *

Youth's Phone Number *

Date of Baptism (if applicable) *

Mother'sName *

First

Last

Mother's Email *

Mother's Phone Number *

Date of Confirmation (if applicable) *

Mother's Address *

Line 1

Line 2

City

State

Zip Code

Country

Father's Name *

First

Last

Father's e-mail *

Father's Phone Number *

Father's Address (if different) *

Line 1

Line 2

City

State

Zip Code

Country

Youth’s Interests and Activities: *

Please fill out separate registration forms for each sibling in the Youth Group. After clicking "Submit" below, return to the Youth Ministries page and click the link for this page again. Thanks for the extra effort!

Does your youth have allergies or any other medical conditions of which we must be aware? *

Yes No

If yes, please explain (and suggest safe/appropriate snacks, if applicable) *

Emergency contact info during church school hour: *

Do you give permission for your child's picture to be published on our website, facebook, e-mails and print publications? *

Yes No

Submit

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