SHINE!

REGISTRATION SHEET

  (St. Mark High School Youth Group)

YOUTH’S NAME: ______________________________________________  

GRADE IN SCHOOL: ____    SCHOOL ATTENDING: _________________

YOUTH’S ADDRESS: ___________________________________________

___________________________________________________________

YOUTH’S CELL PHONE NUMBER: (     )_______________

Allowed to send/receive text messages? ____Yes     _____No

YOUTH’S EMAIL ADDRESS: ______________________________________

YOUTH’S BIRTH DATE: ___/___/___

BAPTIZED? ___YES   ___ NO   If so, Where & When? ____________________

CONFIRMED? ___ YES ___NO If so, Where & When? ___________________

GUARDIAN’S NAME: _____________________________________________

RELATIONSHIP: ______________________________

ADDRESS (if different than above): _________________________________

______________________________________________________________

GUARDIANS’S Cell #: (    )______________

Send/Receive text messages?  ___Y ___N

FAMILY EMAIL ADDRESS: ________________________________________

(all SHINE! correspondence will be sent here unless we are told otherwise!)

OTHER GUARDIAN’S NAME: ________________________________________

RELATIONSHIP: ______________________________

ADDRESS (if different than above): ____________________________________

_______________________________________________________________

Cell #: (    )____________________

Send/Receive text messages? ___Y ____N