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2026-2027 Youth Registration

Welcome friend, we're so glad you're here! We want to know a little more about you so we can love you oh so well this school year! Even if you filled out a similar form for us last year, we want to double check that all of our information is correct. All the information provided will remain confidential to Abby Dwiggins & your youth ministry team. If you're uncomfortable answering a question, please answer with N/A. If you have a sibling (who is also a youth), fill out another form for the sibling and you put N/A to by-pass the parent specific questions.

Youth: First & Last Name *

Youth: Birthdate *

Youth: Grade in School, Fall 2026 *

Youth: Home Address *

Youth: Phone Number *

Youth: Email Address *

Youth: Can we add you, to our weekly email list? This is specific to email's sent to the NPMC Youth Ministry email list. This is not one-on-one communication between Youth Director and youth. *

PARENT CONSENT REQUIRED: COMMUNICATION RELEASE: Do you consent to the Director of Youth Ministry and Head Pastor communicating directly with your youth named above through text, phone call, and email without yourself or another parent/legal guardian's presence in the conversation? *

PARENTS CONSENT REQUIRED: PHOTO RELEASE: Do you consent to pictures taken of your youth (named above) to be publicly released for the public promotion of both New Philadelphia Moravian Church and NPMC Youth Ministry? Release includes but is not limited to Facebook, Instagram, the church website, and physically printed pictures throughout the church. *

Youth: Do you have any allergies? If yes, please describe them below. *

Youth: Do you have any dietary restrictions? *

Youth: What is your favorite snack? Candy? Drink?

Youth: What do you want to see in our youth ministry in 2026-2027? Suggestions? Critiques? Ideas? Events? Hopes?

(A) Parent/ Guardian: First & Last Name *

(B) Parent/ Guardian: First & Last Name

(A) Parent/ Guardian: Mobile Phone Number *

(B) Parent/ Guardian: Mobile Phone Number

(A) Parent/ Guardian: Email Address *

(B) Parent/ Guardian: Email Address

(A + B) Parent(s)/ Guardian(s): Can we add you to our weekly email list? *

What would you like to see in our youth ministry for 2026-2027? Suggestions? Critiques? Ideas? Hopes?

How would you like to use your gifts & graces in our NPMC Youth Ministry? *

PRINT YOUR FULL NAME: As a parent/legal guardian of the youth named above, I print my full name and give my signature in acknowledgement of the following: - I read each individual question in its entirety. - I answered each question to the best of my knowledge - I personally answered the two questions: (a) regarding consent for the direct communication between Director of Youth Ministry and Head Pastor and my youth (b) regarding consent for the public release of any photo taken of my youth during NPMC Youth Ministry events *

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