YLA '24

Only One Child Per Form, Please!

* Indicates required field

Child's Name *

Parent/Guardian's Name *

Address (#, Street, City, State, Zip) *

Mailing Address (if different) *

Main Phone Number *

Secondary Phone Number *

E-mail Address *

Age Information

Birthdate of Child *

Current Grade in School *

Medical Information

Allergies (including food-related) and Any Other Medical Info We Need to Know *

Emergency Contacts

Name *

Phone *

Name *

Phone *

NOTICE: Please be aware that by registering for Young Lives Ablaze ‘24 and signing below, you are giving participating churches permission to photograph your child during the event and use these photographs for the purpose of church promotion in-house and online.

Please check to the box to confirm your agreement. *

I Accept These Terms

Please Write Your Name Representing Your Online Signature *

Submit

Young Lives Ablaze 2024

Registration Form
April 20, 2024 @ 10am
Drop-Off Time: 9:30 to 9:45 | Bring Your Children to Parkland Baptist Church

Only One Child Per Form, Please!

Age Information

Medical Information

Emergency Contacts

Services

PROGRAMS

Young Lives Ablaze 2024

Registration FormApril 20, 2024 @ 10amDrop-Off Time: 9:30 to 9:45 | Bring Your Children to Parkland Baptist Church

Only One Child Per Form, Please!

Age Information

Medical Information

Emergency Contacts

Services

PROGRAMS

Registration Form
April 20, 2024 @ 10am
Drop-Off Time: 9:30 to 9:45 | Bring Your Children to Parkland Baptist Church