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RLM Youth Registration
This form is used to capture data for Restored Life Ministries Youth Ministry. Information entered will be used to keep track of each child and to also keep in contact with the parent or guardian through text messages or emails.
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* Indicates required question
Email Address
Your answer
Child First & Last Name
*
Your answer
Child Age
*
Your answer
Child Birthday
*
MM
/
DD
/
YYYY
Current Grade Level & School Name
*
Your answer
Child Allergies (Leave blank if none known)
Your answer
Child's Medical Issues (Leave blank if none known)
Your answer
Parent or Guardian's Name
*
Your answer
Parent or Guardian's Phone Number
*
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Please email a photo of your child to
rlmyouthmin@gmail.com
You can use your cell phone to take a pic. This will be used to check-in your child each week. It will not be used on any social media sites.
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