Youth Application Today's Date * MM DD YYYY Please check the appropriate box: * Little Saints My Father's Daughter My Father's Son Teen Ministry Child's Information: Name * First Name Last Name Date of Birth * MM DD YYYY Age * Gender * Male Female Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Cell Phone (###) ### #### Email Parent Information: Name of Parent/Care Giver * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Cell Phone (###) ### #### Email * Person legally responsible for this child, other than parent First Name Last Name Emergency Contacts Contact Name #1 * First Name Last Name Relationship * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Cell Phone (###) ### #### Contact Name #2 * First Name Last Name Relationship * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Cell Phone (###) ### #### Children living in the household under the age of 18 I give permission for the photographs or videotapes of my person, taken during activities in the program to be used in promotion of the program, to be used in promotion of the program, Victorious Living CLC ministries presentation, and / or other lawful purpose. I waive any right that I may have to inspect and / or approve the finished products * Accept Decline Thank you!
