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ONE DAY 2020
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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
Antigua and Barbuda
Bahamas
Barbados
Belize
Canada
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Nicaragua
Panama
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Columbia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea-Bissau
Côte d\'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
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!