Book Club for Youth
Thank you for your interest in Book Club for Youth!
We will meet Tuesdays, July 13-August 3, 7-8 pm CDT via Zoom.
Submitting this form is the first step to getting started. Someone on our team will be in touch with you shortly.
Child Safety
The safety of your child is of utmost importance to us. To ensure your child’s safety while joining us for our virtual book club, the following safety measures have been taken. The facilitator is a DCFS certified Mandated Reporter. All Zoom meetings will require a password to enter and participants will only be allowed to join after approval by the facilitator. Children will use their first name only. Private chat in Zoom will be disabled so all interactions by participants will be monitored by the facilitator. Exodus will not share your child’s personal information with the other members of the book club. While the book club is for middle and high school students, parents are welcome to join anytime.
Please contact Jody May with any questions, 847.514.9924 or
[email protected]
.
*
Required Fields
Parent Contact Information
*
First Name
*Required
*
Last Name
*Required
Address
City
*
State
*Required
Outside the U.S.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
Zip Code
Cell Phone
Home Phone
Work Phone
*
Email
*Required
Your entry is not a valid email address!
Spouse First Name
Spouse Last Name (If Different)
Child Information
Child 1 Name
Date of Birth
mm/dd/yyyy
mm/dd/yyyy
Gender
Female
Male
Child 2 Name
Date of Birth
mm/dd/yyyy
mm/dd/yyyy
Gender
Female
Male
Child 3 Name
Date of Birth
mm/dd/yyyy
mm/dd/yyyy
Gender
Female
Male
Child 4 Name
Date of Birth
mm/dd/yyyy
mm/dd/yyyy
Gender
Female
Male
Child Safety Agreement
I acknowledge that I am over the age of 18 and that I am the parent of the child(ren) listed above. I give my child(ren) permission to attend the Exodus World Service Book Club for Youth on Tuesdays at 7:00 PM CDT via Zoom. I have read and agree to the Child Safety measures listed at the top of this page.
*
Name
*Required
You can view our privacy policy:
https://exodusworldservice.org/privacy-policy/
©2024 SofterWare, Inc. v.2024.01-C
