Youth Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Youth 2 Name

First Name

Last Name

Youth 2 Date of Birth

MM

DD

YYYY

Youth 3 Name

First Name

Last Name

Youth 3 Date of Birth

MM

DD

YYYY

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent 1 Name *

First Name

Last Name

Parent 1 phone number

(###)

###

####

Parent 2 Name

First Name

Last Name

Parent 2 Phone Number

(###)

###

####

Image Consent

I give Grace Bible Fellowship church permission to use the images from photography/videography filming of my child participating in youth group. This may include Grace Bible Fellowship's website and/or social media pages (Facebook or Instagram).

Yes

No