Please enter the name(s) of the parent(s) or guardian(s) responsible for the child/youth.
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Street Address *
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City *
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State *
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Zip Code *
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Cell Phone with area code *
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Home Phone with area code
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Emergency Contact (please write either 'parent' and we'll use the information above or write the name and phone number of the emergency contact) *
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We often take photographs of activities and events. These photos may be displayed on the church's website, Facebook page, newsletters, bulletin board or local newspapers. We will not publicize photos of your children without your consent. *