REGISTRATION FORM Full Name* First Last Birthdate MM slash DD slash YYYY Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell #Texting?* Yup Nope Email* School Grade* 6th 7th 8th 9th 10th 11th 12th None of the Above or Not Sure (explain) Parent/Guardian's Cell # (for emergencies)*Relationship to you?* Do you attend church?* Yup Nope Which one?* This one? (Grace Church) Other If this is your first visit, who invited you or brought you? Name of Person Filling Out the Form* First Last Questions or Comments
