Youth Name *

First Name

Last Name

Youth Birthday *

This helps us celebrate!

MM

DD

YYYY

Youth Phone

for leaders to occasionally txt/call

(###)

###

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Youth Address

for occasional mailings

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Parent/Guardian Contact *

this includes for events, updates, questions, etc.

First Name

Last Name

Primary Contact Phone # *

(###)

###

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