Youth Registration
YOUTH:
Last Name: * 
First Name: * 
Address: * 
City/State: * 
Main Phone #: *  
2nd Contact #: 
Email: *  
Date of Birth (mm/dd/yy): * 
Age: 
Gender: *
 
Grade (Fall 2016): * 
Does you have any medical conditions (allergies, medications, etc.) that we should be aware of?
Allergy/Meds?:
If yes:
Parent /Guardian Information
Last Name: * 
First Name(s): * 
Contact #: *  
Email: 
Home Church:
Emergency Contact Information Needed for Students (6:00 - 9:30pm WCB events):
Name: * 
Phone #: *  
Name:
Phone #: 
Thank you for completing this form to help us stay in better contact with you!

If at anytime you have a change in your contact information, please feel free to resubmit this form at your convenience.

We hope you have a wonderful day!
WCB Staff
South Dakota Website Design and Development