The Presbyterian Youth Connection

Kiski Youth Council Youth Application Form

Name Birth Date Age

Address Zip Phone

Email address

Nickname Gender: Female Male Grade in School (99/00)

Church Membership Approx #years family has been members

Mother's Name Father's Name

Resides with: Both Parents Mother Father

1. Why are you interested in being a member of the Kiski Youth Council?

2. Please describe your current participation in your local congregation. Include any involvement in youth ministry programs.

3. Are you available for meetings approx. one a month in Jan-April and Sept-Nov on Sunday evenings from 5:00-7:00 in Punxsutawney? Yes No (circle one)

Youth Signature Date

I hereby give my permission for my son/daughter to apply for the Kiski Youth Task Force:

Date

Signature of parent or legal guardian

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I believe that should be a member of the Kiski Youth Task Force because:

Signature Date

Responsibility in church Phone