Youth Group Registration

Please fill in the form below and submit.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Current school *

Email *

Phone Number *

How to contact you: *

Do you attend church? Where? *

Grade currently in *

Mother's Name *

First

Last

Mother's Phone *

Father's Name *

First

Last

Mother's Email *

Father's Email *

Father's Phone *

Emergency Contact other than parents *

First

Last

Relationship to you: *

Phone Number *

I hereby grant permission to Highland Christian Church to use photographs and/or video of me taken during youth group in publications, news releases, online, and other communications related to the mission of Highland Christian Church's Ignite Ministries and the Youth Group Ministries. *

YES No

Submit

​REGISTRATION

Please fill in the form below and submit.

REGISTRATION