University Presbyterian
3240 Dalrymple Drive
Baton Rouge, LA  70802

(225)383-0345
(225)383-3495 FAX
Youth Group Information Form

To make things easier and more environmentally friendly, UPC is moving our Youth Information Form online.  Please complete this information about your youth for our records.  Information will be kept and shared with youth leaders as needed.  Please update your information as necessary.

Youth Information Form
* Required
First Name *
Last Name *
 
Email Address * (For example: name@company.com)
 
Birthday
 
Address Line 1
Address Line 2
City
State
Zip Code
 
  Area Code Phone Number  
Home Phone *
  
Mobile Phone
  
Work Phone
 Ext 
 
Grade *
 
Health Insurance Information *
 
Emergency Contact #1 *
 
 
 
This information is to protect the safety of our youth and to make sure they have the best youth group experience possible.
Last Published: October 1, 2008 8:11 PM
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