Children/Youth Membership

New Visions Baptist Church Children and Youth Membership Affirmation Form for grades K5-12th.

My child is joining as (Required)

Gender (Required)

Child's First Name (Required)

Child's Last Name (Required)

Child's Birthdate (Required)

Child's Cell Phone (if teenager)

Current Grade (Required)

Address (Required)

City (Required)

State (Required)

Zip Code (Required)

First Name (Required)

Last Name (Required)

Relationship to Child (Required)

Parent/Guardian's Cell Phone (Required)

Parent/Guardian's E-mail Address (Required)

First Name (Required)

Last Name (Required)

Emergency Number (Required)

Medical Conditions