Market Street church of Christ
Youth Bible Study 2009
Registration Form
First Name
Last Name
Age
Grade
4
5
6
7
8
9
10
11
12
13
14
15
16
17+
Address
City
State
Zip
Email
Phone (Home)
Phone (Cell)
Home Congregation
Will you need transportation
during the weekend?
Yes
No
Are you willing to drive others
during the weekend?
Yes
No
# of seats (minus driver)
Will you need housing Friday night?
Yes
No
Will you need housing Saturday night?
Yes
No
Preferred host family?
Please list the names of those with
whom you would like to be housed:
Are you willing to
lead a song
lead a prayer
no thanks/not applicable
A parent/legal guardian must complete a
Medical Release Form for each participant
under 18 years.
I understand.
If you are 18 or older, would you like
to provide an emergency contact?
Any special needs?
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