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NBC Youth/Parent Information
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* Indicates required question
Teenager's Name
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Grade Entering (2021-2022)
*
Choose
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Does your teenager drive to youth group?
*
Choose
Yes
No
My teen will begin to drive at some point this year...yikes!
Physical Address (and mailing address, if different)
*
Your answer
Parent's Email Address (if you would like to receive weekly parent emails/youth updates-you know you want to!)
Your answer
Father's Name
Your answer
Father's Phone #
Your answer
Mother's Name
Your answer
Mother's Phone #
Your answer
Best Phone # to call or text
*
(In the event of an emergency or if you need to be contacted for some reason)
Your answer
What is the best method to reach you?
(text message, phone call, or email)
Text Message
Phone Call
Email
I don't care, you choose!
Is there anything else you would like us to know?
Allergies, medical conditions, etc
Your answer
Would you like to schedule a meeting with Von Vargo?
Yes
No
Clear selection
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