LUMC Youth 2020-2021 Registration

LUMC Youth - Registration for 2020/2021

Thank you for helping us update our records for LUMC Youth. Once we're back to in-person meetings and off-site adventures, we'll complete a hard copy of our Health Record/Medical Emergency/Liability Release Form. But for now this will help us keep up with new schools and birthdays. Thanks!

STUDENTS' INFORMATION
Student's Full Name (First, Middle, and Last)
Student's Preferred Name (if other than first name)
Student's Date of Birth*
MM
/
DD
/
YYYY
School attending in Fall 2020*
Grade level for the 2020-2021 School Year
Home Phone
Student's Email (if different from parent's)
Street Address
Address Line 2
City
Province / State / Region
Postal Code / Zip
Country
PARENT(S)' CONTACT INFORMATION
Mom's Name
First Name
Last Name
Mom's Cell Phone
Mom's Email
Dad's Name
First Name
Last Name
Dad's Cell Phone
Dad's Email
If there are additional contacts (grandparents, step-parents, etc.), please provide any additional info here:
This information will be used to add you to the list to receive our weekly Youth Email (separate from the church email). Questions? Please contact Marlene Passarelli (marlene@lynnhaven.church). Thanks!