Youth Registration – Jesus People - Smithville First Christian Church

12 weeks of bible study

Jesus People

A 12-Week Discipleship Pathway for Teens

Typically meets on Wednesdays from 7 p.m. to 8:30 p.m. in the Smithville First Christian Church Fellowship Hall.

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Child's Name

First

Last

Name Child Goes By (optional)

Date of Birth

Child Primary Address

Address Line 1

Address Line 2

City

State

Zip Code

High School Graduation Year

Allergies / Medical Information

Please list (describe as necessary) any allergies or medical issues of which supervising adults should be aware. (If none, indicate by typing n/a).

Parent or Guardian #1

First

Last

Phone Number (Parent / Guardian #1)

Preferred Method of Contact (Parent / Guardian #1)

Phone call
Text
Email

Parent or Guardian #2

First

Last

Phone Number (Parent / Guardian #2)

Preferred Method of Contact (Parent / Guardian #2)

Phone call
Text
Email

Photo Consent Opt-Out

Do NOT use my child’s photo

If we have your consent to use photos of the child listed above, leave the box unchecked. By not checking the box you are indicating your consent for using photos of the child listed above in the SFCC website, social media and print materials.

Signature

Type your name in the above field to serve as your signature. By signing this form, I agree to the terms and conditions of the Liability Release Waiver and First Aid and Emergency Medical Treatment Waivers linked to below.