Register for Cosmic Detour

Youth's Information

Youth's Name:

Parent/Guardian's Name:

Grade (Fall 08): 7th 8th

Baptismal Date:
Year: 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 Month: January February March April May June July August September October November December Date: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Gender: Male Female

Has this youth received first communion? Yes No

Food/Medication Allergies:

Does this youth have any special needs (physical, emotional, or developmental)?
Yes No
If so, explain:

Contact Information

Parent/Guardian's Name:

Home Phone: ( ) -

Mailing Address:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:

Email Address:

Parent/Guardian's Name:

Home Phone: ( ) -

Mailing Address:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:

Email Address:

Parent(s)/Guardian(s) How will join in this faith journey with your child?

I will serve as a Cosmic Detour Guide - Come the same time as your youth, build relationships with youth in the congregation and lead them in discussions.
I will serve as a partner Cosmic Detour Guide - same as above, working with another adult.
I will serve as a substitute Cosmic Detour Guide - fill-in when other guides are not able to be present.

Questions/Comments: