Middle School Youth Group Registration Form CAPTCHAChild's Name* First Last Age*Please enter a number from 11 to 14.Date of Birth* MM slash DD slash YYYY T-Shirt Size*Child LargeAdult Extra SmallAdult SmallAdult MediumAdult LargeAdult Extra LargeSchool* Grade*Please enter a number from 6 to 8.Do you have any food or drug allergies?* Yes No Please list any food or drug allergies.* Do you have any medical conditions?* Yes No Please list medical conditions.* Is there anything else we should know?*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother's Name* First Last Mother's Cell*Mother's Email* Email Usage* Regular Updates Urgent Only Father's Name* First Last Father's Cell*Father's Email* Email Usage* Regular Updates Urgent Only Emergency Contact (other than parent)* First Last Emergency Contact Relationship to Teen Emergency Contact Cell*
