First Name: Last:
Address:
City: Zip Code:
Phone: Cell:
Grade: 7th8th9th10th11th12th School:
Birthday: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 12345678910111213141516171819202122232425262728293031 /
Do you have: Texting? Yes No (& want texts from the youth group)
Facebook? Yes No
Myspace? Yes No Name -
Email:
Parents' Names:
Favorite Cartoon Character?:
Favorite Color?:
Favorite Pizza Topping?:
Favorite Movie?:
