Youth Registration Form • CROSSROADS CHURCH

Youth Registration Form

First Name *

Allergies

Last Name *

Mobile Number *

Email Address *

Home Address *

Home Address Line 2

Home City *

Home Zip Code *

Home State *

School Grade

Campus/Service *

Lakeville (9:30AM Sun. 5:30PM Wed.)

Inver Grove Heights (10:30AM Sun. 5:30pm Wed.)

Emergency Contact #1

First Name *

Last Name *

Phone Number *

Email Address *

Emergency Contact #2

First Name

Last Name

Phone Number

Email Address