Student Registration

PAC YOUTH REGISTRATION

PAC Youth includes 6th - 12th grades. Please fill out the form below to register students for the 2021-2022 season.

PAC Youth Registration 2021-2022

Parent/Guardian Information:

* Indicates required field

Parent/Guardian 1 Name *

First

Last

Parent/Guardian 2 Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Is this a cell phone? *

Email *

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Student 1:

Name *

First

Last

Email *

Date of Birth *

Age *

Phone Number *

Grade *

School *

Favorite Snack *

Allergies *

Favorite Drink *

Student 2:

Name *

First

Last

Email *

Date of Birth *

Age *

Phone Number *

Grade *

School *

Favorite Snack *

Allergies *

Favorite Drink *

Student 3:

Name *

First

Last

Email *

Date of Birth *

Age *

Phone Number *

Grade *

School *

Favorite Snack *

Allergies *

Favorite Drink *

Photo Consent

May your student(s) be photographed and may the picture appear in church articles or on our website (no names will be attached with the picture)?

Select One *

Submit

REQUIRED: Additional Printed Form

Please PRINT and COMPLETE the Medical Release form linked below.
It many be returned to the church office or to Pastor Anders directly.

Medical Release