Junior High Registration 2019-2020

To participate in our fun Junior High Activities including Confirmation and Brunch Bunch, all youth must fill out our online registration form. Luckily—you need to fit out this registration form just once a year! Register now for all Junior High Activities for the 2019-2020 Program year. Once you are registered you WILL NOT receive a confirmation email. If you have any questions, please email Tammie at confirmation@hslckirkland.org.

Youth Name *
Youth Name
Address *
Address
Student Cell Phone
Student Cell Phone
Baptized
Home Phone Number
Home Phone Number
Parent/Guardian 1
Parent/Guardian 1
Parent/Guardian 1 Cell Phone
Parent/Guardian 1 Cell Phone
Parent/Guardian 2
Parent/Guardian 2
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Cell Phone
Emergency Contact (other than parents)
Emergency Contact (other than parents)
Emergency Contact Phone Number
Emergency Contact Phone Number
I give my permission for my child to participate in these activities which will be led by Safe Haven trained adults. Please select all that apply.
Please write your name below