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  • 6th Grade Ministry
    Registration Form

  • Teen Information

  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Address REQUIRED Please fill out this field.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  • Gender REQUIRED (Select One) Male Female Please fill out this field.
  • Grade in Fall 2021 REQUIRED (Select One) 6th Please fill out this field.
  • School Attending REQUIRED Please fill out this field. Please enter valid data.

  • Parent Information

  • Father's Name REQUIRED Please fill out this field. Please enter valid data.
  • Father's Cell Phone REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Name REQUIRED Please fill out this field. Please enter valid data.
  • Mother's Cell Phone REQUIRED Please fill out this field. Please enter valid data.
  • Primary Residence REQUIRED Both Father Mother Please fill out this field.
  • Best Email Address for Contact REQUIRED Please fill out this field. Please enter valid data.
  • Best Cell Phone Number for Contact REQUIRED Please fill out this field. Please enter valid data.
  • I am open to volunteering in the following ways: REQUIRED Adult Core Team (Weekly Youth Group Volunteer) Donate Food Chaperone an Event Chaperone a Retreat Please fill out this field.

  • Registration Fees

  • Would you like a St. Mark Youth Ministry T-shirt? REQUIRED Yes No Please fill out this field.
  • T-Shirt Size S M L XL
  • Registration Fees REQUIRED

    15.0 –  T-Shirt Fee

    25.0 –  Donation to General Youth Ministry Expenses Please fill out this field.

  Total:

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