Youth and KFC Profile

HEY, THERE!

If you are in the Youth Group (Grades 7-12) or Kids For Christ (Grades 3-6) at the Brown Street Church of Christ in Waxahachie, Texas ... THIS FORM IS FOR YOU! Please fill out as much information as you possibly can (if you are in Kids For Christ, have your parents fill it out). This will help us provide the best possible youth ministry and children's ministry for YOU!

NOTE: Your school grade should be based on the 2011-2012 school year.

First Name *

Last Name *

Street Address *

City, State, Zip (for Street Address) *

Mailing Address (only if it is different from your Street Address, like a P.O. Box)

City, State, Zip (for Mailing Address)

Home Phone

Cell Phone (yours, if you have one)

E-mail

E-mail address belongs to

Me

Parent(s)

Someone else: Someone else:

IMPORTANT: By giving us this e-mail address, you are giving us permission to send periodic Youth Group or KFC announcements to this e-mail address. If you do NOT want to receive Youth Group or KFC announcement e-mails at the above e-mail address, please check the box below.

E-mail Opt-Out

I do not wish to receive Youth Group or KFC announcement e-mails at the above e-mail address.

Alternate E-mail

Alternate E-mail address belongs to

Me

Parent(s)

Someone else: Someone else:

IMPORTANT: By giving us this alternate e-mail address, you are giving us permission to send periodic Youth Group or KFC announcements to this e-mail address. If you do NOT want to receive Youth Group or KFC announcement e-mails at the alternate e-mail address, please check the box below.

E-mail Opt-Out (Alternate E-mail Address)

I do not wish to receive Youth Group or KFC announcement e-mails at the alternate e-mail address listed above.

Name of your school (2011-2012 school year) *

What city is your school in? *

School grade (2011-2012 school year) *

Birthday Month *

Birthday Day *

Birthday Year *

Have you been baptized? *

Yes

No

Do you have a Facebook page? *

Yes

No

Hobbies and Interests

School Activities, Clubs, Sports

T-shirt size

Special requests for the Youth Group or Kids For Christ (activities you'd like to do as a group, suggestions, etc.)