FM | HS Youth Group

* First Name

* Last Name

* Gender

* Email

* Address

* Birth Date (mm/dd/yyyy)

* Parent/Guardian Name

* Parent/Guardian Phone #

* Parent/guardian email address if different from above

* Any allergy information we should be aware of?

* Can our staff administer over the counter medication to your child?

* Any medications that your child is taking that we should be aware of?

* Is there anything we should be aware of that will help us serve your child best (sensory needs, physical abilities, behavior cues, etc)?

* Can we use pictures with your child(ren) on social media and/or in church publications?

* High School Graduation Year