Facebook X (Twitter) Instagram Flocknote

Youth Group Registration

- 2026 - 2027 Middle and High School Youth Group Registration
  
  This form is not accepting responses at this time.
  
  Number of Children Please fill out this field.
  
  Teen 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Biological Sex REQUIRED Please fill out this field.
  
  Grade in 26/27 School Year REQUIRED Please fill out this field.
  
  School Attend REQUIRED Please fill out this field. Please enter valid data.
  
  Teen Email Please enter an email address.
  
  Teen Cell Phone Number Maximum 20 characters
  This will only be used to remind of events coming up. We will only contact through FlockNote and never from our personal cellphones.
  Please enter a phone number.
  
  Teen 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Biological Sex REQUIRED Please fill out this field.
  
  Grade in 26/27 School Year REQUIRED Please fill out this field.
  
  School Attend REQUIRED Please fill out this field. Please enter valid data.
  
  Teen Email Please enter an email address.
  
  Teen Cell Phone Number Maximum 20 characters
  This will only be used to remind of events coming up. We will only contact through FlockNote and never from our personal cellphones.
  Please enter a phone number.
  
  Teen 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Biological Sex REQUIRED Please fill out this field.
  
  Grade in 26/27 School Year REQUIRED Please fill out this field.
  
  School Attend REQUIRED Please fill out this field. Please enter valid data.
  
  Teen Email Please enter an email address.
  
  Teen Cell Phone Number Maximum 20 characters
  This will only be used to remind of events coming up. We will only contact through FlockNote and never from our personal cellphones.
  Please enter a phone number.
  
  Teen 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Biological Sex REQUIRED Please fill out this field.
  
  Grade in 26/27 School Year REQUIRED Please fill out this field.
  
  School Attend REQUIRED Please fill out this field. Please enter valid data.
  
  Teen Email Please enter an email address.
  
  Teen Cell Phone Number Maximum 20 characters
  This will only be used to remind of events coming up. We will only contact through FlockNote and never from our personal cellphones.
  Please enter a phone number.
  
  Teen 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Biological Sex REQUIRED Please fill out this field.
  
  Grade in 26/27 School Year REQUIRED Please fill out this field.
  
  School Attend REQUIRED Please fill out this field. Please enter valid data.
  
  Teen Email Please enter an email address.
  
  Teen Cell Phone Number Maximum 20 characters
  This will only be used to remind of events coming up. We will only contact through FlockNote and never from our personal cellphones.
  Please enter a phone number.
  
  Parent Contact Information
  
  Primary Email REQUIRED Please fill out this field. Please enter an email address.
  
  Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Steet Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Mother's Contact Information
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Father's Contact Information
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Youth Ministry Donation
  There is no set fee to participate in Youth Group, however, to help cover the cost of food, technology, materials, etc., a donation amount of $25 to $100 per teen would be greatly appreciated. If you are unable to donate or would like to pay later, just click the Pay Later option. It will not bill if you select that option.
  
  Donation Amount $ Please enter a positive decimal.
  
  Total:
  
  Submit
  
  Make Payment
  
  Pay Later