Youth Events Registration
Please fill out this form and click submit.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Grade in School
*
DOB
*
Other Children
DOB and Grade in School
Other Children
DOB and Grade in School
Parent/Guardian & Relationship
*
Parent/Guardian & Relationship
*
Medical Conditions, Special Needs, And/or Allergies
Emergency Contact
*
Emergency Contact Phone
*
My children have permission to walk home from youth group.
Please select all that apply.
yes
no
Who May Pick Up My Children
*
I give permission for my children's photo to be used in Chadron Christian Church's social sites.
*
Please select all that apply.
Yes
No
By submitting this form you are agreeing to your child/children's participation in Chadron Christian Church's Youth Programs.
Please check which event you are registering for
Please select all that apply.
Sunday Mornings
VBS
Wednesday Nights
Submit
Description
Please fill out this form and click submit.
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