This form must be filled out by the parent or guardian of the teen only.
 We cannot post pictures of anyone unless we have the consent of an adult

Please fill out to the best of your ability.


Primary Contact
Secondary Contact
Birth date:
Example: 12/25/0000

Teen Shirt Size
Phone Number-
(Area Code)- 555-1212
Teen Cell:
Primary Cell :
Secondary Cell:
Email address -
Teen Email:
Primary Email
Secondary Email

Do we have permission for your teen to appear in website pictures?





Avon Grove Church of the Nazarene
240 State Rd
West Grove, PA 19390
Office Phone - 610-869-9500
Avon Grove Nazarene Academy
240 State Rd.
West Grove, PA 19390
Office Phone - 610-869-9530