Youth Group Registration Thank you for your interest in our Youth Ministry program here at San Jose. Please complete the registration form to receive all the latest news and activities for our Youth Group! Date*Today's Date Date Format: MM slash DD slash YYYY Youth Program*Select the age appropriate youth program for your childJr. Youth - 6th, 7th & 8th GradeSr. Youth - 9th, 10th, 11th & 12th GradeName of Youth* First Last Preferred NameWhat is the preferred name that you go by?Date of Birth*Please enter your date of birth Date Format: MM slash DD slash YYYY Address - include Apt. Number* Street Address Apartment/Unit Number City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Youth's cell phone numberEmail*Youth's email Enter Email Confirm Email ReligionCatholicBaptistProtestantChristianSchool*What school do you attendGrade*6th Grade7th Grade8th GradeGrade*9th Grade10th Grade11th Grade12th GradeT-Shirt Size*Please indicate other sizing by selecting otherYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult Extra LargeWhat are your special talentsPlease share with us any special talents that you have eg. Play a musical instrument - can lick my elbow...Family InfoFirst Parent/Guardian*Name of Parent or Guardian responsible for Youth Registrant Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian Phone*Parent/Guardian Email* Second Parent/Guardian Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian PhoneParent/Guardian Email
