YOUTH Registration (Grades 6-12)
You may register more than one youth using this form.
First Name Youth #1
First Name Youth #2
First Name Youth #3
First Name Youth #4
Last name:
Home Address:
ZIP Code
Parent's Name/s:
PARENT cell number
PRIMARY Parent Email Address
#1 Youth email adress:
#2 Youth email adress:
#3 Youth email adress:
#4 Youth email adress:
#1 Youth Date of Birth: Month/Day/Year
#2 Youth Date of Birth: Month/Day/Year
#3 Youth Date of Birth: Month/Day/Year
#4 Youth Date of Birth: Month/Day/Year
#1 Youth Grade this Fall:
#2 Youth Grade this Fall:
#3 Youth Grade this Fall:
#4 Youth Grade this Fall:
REGISTER for: Check ALL that apply
Confirmation (7th & 8th grade)
Sunday School (9th thru 12th grade)
6th Grade Wednesday Night Group (6th grade only)
Wednesday Night Youth Group (7th thru 12th grade)
Allergies: (Please explain for each child.)
Special Needs or restrictions:
Doctor's Name:
Emergency Contact Name and phone number in case parent cannot be reached:
Hospital Preference:
Choose one:
St. Luke's
Essentia
Other: please note in Emergency Contact section
Insurance Company:
Policy #
Group #
Policy Holder's name:
I/We give permission for our (my) student to ride in any vehicle designated by the adult in whose care he/she has been entrusted while attending and participating in Lakeview activities.
yes
no
May student's photo be included in Lakeview;'a publications or website?
yes
no
SUBMIT FORM
Success! This form has been submitted. Please note this is not an automated registration system. Information is manually entered by staff during office hours. Thank you!