Youth Night – Henk Kleinschmidt

REGISTER HERE:
For Grades 6th - 12th

I heard about Youth Night from:
Word of MouthEmailSocial MediaFlyerRadioNewspaper

First Name (required)

Last Name (required)

Grade/Year (required)

Your Email (required)

Phone (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Who invited you?

Parent/Guardian First and Last Name (required)

Parent/Guardian Email (required)

Parent/Guardian Address (required) or enter same as student

Parent/Guardian phone number (required)

Emergency Contact Name and relationship (required)

Emergency Contact Telephone number (required)

Allergies

Medical Concerns/Information you would like us to know

By entering my name below, I, as parent or legal guardian of the student being registered, give permission for my child to participate in Youth Night through Frontline Ministries International. I give Frontline Worship Center/ Frontline Ministries International permission to treat my child/children in case of accident or injury, and I will not hold them responsible/liable for said incidents. I also understand that pictures and or videos made be taken of Youth Night. I, as a parent or legal guardian give permission to Frontline Ministries International to take and/or use photos or videos of my child for any legal use, including but not limited to: publicity, advertising, web content. Frontline Ministries International may also store my and my child's information electronically and may use it to communicate with my child about activities' via email, text messages, and/or phone calls.

Parent or Legal Guardian Full Name