Rock-n-Reef Youth Zoom Online Registration

 

Registering for Youth Zoom is easy with our online registration form. Simply fill in the form below and click "Submit Registration Form ". Please make sure that all information is correct prior to submitting forms. Only one form is required per family. Form fields with and asterisk (*) are required. Please accompany Youthren to the check in desk on the first day as a signature from a parent or legal guardian will be required to complete the registration.

Youth Zoom is FREE and open to youth's who have completed 6th and/or 7th grade!

Thank you for your cooperation.
Northside Baptist
Youth Zoom Online Registration form
2009
Parent/Guardian information

Parent 1 Name(*):

Parent 2 Name:

Address(*):

City(*):

Zip(*):

Home Church:

How did you hear about VBS?:

Home Phone(*):

Work Phone:

Cell Phone:

Email(*):

Can we take your Youth's picture?: Yes No

Who may pick up your Youth at the end of each day?(*):

 
Emergency Contact Information

Name(*):

 Phone(*):
1st Youth's Information

Name(*):

Birthdate(dd/mm/yyyy)(*):

Age(*):

Last grade completed(*):

 Medical or other information we need to know (please include any food allergies):
2nd Youth's Information

Name:

Birthdate(dd/mm/yyyy):

Age:

Last grade completed:

 Medical or other information we need to know (please include any food allergies):
3rd Youth's Information

Name:

Birthdate(dd/mm/yyyy):

Age:

Last grade completed:

 Medical or other information we need to know (please include any food allergies):
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Northside Baptist Church - 7965 Oswego Rd. - Liverpool, NY 13090 - (315) 652.3160
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