FAC Youth Department
Contact Information Form

First Name

Last Name

Your Email

Birthdate

Gender

Male

Female

Your Phone Number

Parent/Guardian Name

Parent / Guardian Email

Parent - Guardian Address

Apartment, suite, etc.

City

State

Zip/Postal Code

School & Grade

Are you current a member of Faith Assembly?

Do you believe in God?

Yes

No

Have you been baptized in the name of Jesus Christ?

Yes

No

Have you recived the Holy Ghost?

Yes

No

Waiting

Date when you were bapitized.

Are you currently involved in any After School Programs of clubs?

FAC Youth DepartmentContact Information Form