Youth Group Registration Form

Register young people to the youth group here.

Questions for Youth Group Registration Form

1.

Youth Name

The answer should be a text input.
2.

Age

The answer should be a number input.
3.

Date of Birth

The answer should be a date input.
4.

Phone Number

The answer should be a phone number.
5.

Email Address

The answer should be a email input.
6.

Address

The answer should be a text input.
7.

City

The answer should be a text input.
8.

State

The answer should be a text input.
9.

Country

The answer should be a country.
10.

Zipcode

The answer should be a number input.
11.

School

The answer should be a text input.
12.

Grade Level

The answer should be a text input.
13.

Insurance Provider Name

The answer should be a text input.
14.

Medical Insurance 

The answer should be a text input.
15.

Does the child have any allergies

The answer should be a text input.
16.

Does the child have any medical conditions that we should be aware of

The answer should be a text input.
17.

Parent/Guardian Information

Name:

The answer should be a text input.
18.

Parent Cell No

The answer should be a phone number.
19.

Relationship

The answer should be a text input.
20.

Payment Method

The answer should be a single choice:
  1. Cash
  2. Check
  3. Credit card
  4. Bank transfer
21.

I agree to follow the guidelines, rules, and policies of the organization.If a chaperone or driver is needed, I'll do that.I allow my child to be photographed or be part of the video that will be used for marketing, promotion, and advertisements.The repeated offense of the youth may result in suspension or expulsion.Parent/Guardian registered in this form has legal custody over the child.I allow my child to ride any vehicle that is related to the group's activities provided that there's an adult on board.For medical emergencies, I allow the medical team of this organization to take care of my child.I release this organization from any and all liability from accident or injury to the child during the organization-related events

The answer should be a single choice:
  1. I give permission for my child to participate in this Youth Group Organization
22.

Parent/Guardian Signature

The answer should be a signature.
23.

Date Signed

The answer should be a date input.

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