SM: CHOSEN Child/Youth/Adult Form

Work Entry

Please fill this section out for the individual attending:

First Name

Last Name

Address

Mobile Phone

Gender

Birthday

/ /

Age

Service/Program Did They Attend:

Sun. 10:45am - Adapted Bible Study (14+) Fri. 6:30pm - Friday Night Friends (14+) Sun. 10:45am - Multi-Sensory Room (4 yrs - 5th Grade)

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