Youth Department Registration

Parent/Guardian Name-Father

Parent/Guardian Name-Mother

Last Name

Street Address

Email Address

This address will receive a confirmation email

Phone

Child's First and Last Name

Please choice a Gender

Child's Birthday

Age of your child

Does your child has any allergies?

Yes No

If yes, please name the allergies your child has or type N/A

Does your child have any health conditions?

If yes, please explain the health condition your child has or type N/A.

Please add the names of people who can pick up your child or put N/A if it does not apply.

Emergency contact name

Emergency contact number

Are you a member at Macedonia Baptist Church?

Yes No I am a visiting but I am thinking about joining

Thank you so much for filling this out. We appreciate your cooperation!

Description

Please fill out this form and click submit.