REGISTRATION FORM Full Name* First Last Birthdate MM slash DD slash YYYY Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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? By attending a Grace Youth event, I am giving my consent for Grace Church to use on their website or in print media all photographs in which I/my child appear(s) while involved in the ministries of Grace Church.* I Agree Name of Person Filling Out the Form* First Last Questions or CommentsUntitled First Choice Second Choice Third Choice
