Student Cell Phone (if applicable)

(###)

###

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Birth Date *

MM

DD

YYYY

Have you been baptized? *

Yes

No

Date of Baptism

MM

DD

YYYY

Cell Phone #1 *

(###)

###

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Cell Phone #2

(###)

###

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I can volunteer as a Small Group Leader

Yes

No

I can volunteer to help with youth events

Yes

No

I want to volunteer on the Youth and Family Team

Yes

No

I can help decorate/maintain the youth room

Yes

No