YHC Sign-up

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

Home Phone Number

Mobile Number

Email Address *

Tip: Please write down your own email address (not your parents'), as it will be needed for group communication later.

Home Address *

Home City *

Home Province *

Home Postal Code *

Allergy

Emergency Contact Name *

Emergency Contact Number *

Emergency Contact Email *

Youth House Church of your choice *

Tip: If you are grade 7-8, choose from "junior" youth shepherds. If you are grade 9-12, choose from "senior" youth shepherds.