SRB Middle School Youth Group Contact Info Form

Parent / Guardian Contact Information

Parent Name

Parent Cell Phone

This address will receive a confirmation email

Address

Home Phone

Parent / Guardian #2 Contact Information

Parent Name

Parent Cell Phone

Middle Schooler #1

Child's Name

Child's Age

Please note any medical conditions or anything else the group leader should be aware of:

Middle Schooler #2

Child's Name

Child's Age

Please note any medical conditions or anything else the group leader should be aware of:

Middle Schooler #3

Child's Name

Child's Age

Please note any medical conditions or anything else the group leader should be aware of:

Description

SRB Middle School Youth Group is for 6th, 7th & 8th Graders and meets on Wednesdays from 6pm-7:30pm in the Youth Room.

Please fill out this Contact Information Form.

There is no cost for SRB Middle School Youth Group.

SRB Middle School Youth Group Contact Info Form

Description

Please Fix the Following