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NCYC Registration 2017 -- St. Clare Parish
Please fill out this form so we may complete your registration with the National Catholic Youth Conference, which will be held Nov. 16-19, 2017, in Indianapolis.
Participant's first name *
Your answer
Last name *
Your answer
Preferred name for badge
Example: Matthew is first name and Matt is the name preferred for the badge
Your answer
Mailing address *
Your answer
City *
Your answer
State (IL) *
Your answer
Zip code *
Your answer
Participant's cell phone *
Your answer
Participant's email address *
Your answer
Participant is adult or youth (under 21) *
select one
Participant's gender *
select one
Emergency contact name *
Your answer
Emergency contact phone *
Your answer
Participant's ethnicity *
select one
Participant's special needs *
select one
Grade at time of NCYC *
Your answer
Date of birth *
Your answer
T-shirt size *
select one (adult sizes)
Youth's Parent/Guardian information
Please complete this section for youth registration. Chaperones do not need to fill out this section, but do need to press submit button below.
Mother/guardian's name
Your answer
Address if different from child
Your answer
Mother/guardian cell phone or home phone
Your answer
Father/guardian's name
Your answer
Father/guardian address if different from child
Your answer
Father/guardian cell phone or home phone
Your answer
Press submit button
Your registration is not complete until you press the submit button.
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