Steubenville Conference Registration
Important! To be filled out by the Parent/Guardian for youth under 18 years of age. If participant is 18 years of age or older, consent must be filled out by the participant.

If a question is not applicable, please answer N/A.

Participant First Name: *
Your answer
Participant Last Name: *
Your answer
Date of Birth: *
MM
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DD
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YYYY
Adult T-shirt Size: *
Grade (Current): *
Age *
Your answer
Sex: *
Youth Cell Phone Number: *
Your answer
Youth Email Address: *
Your answer
School Attending: *
Your answer
Roommate Preferences:
Your answer
Parent/Guardian Name: *
Your answer
Email: *
Your answer
Phone Number: *
Your answer
Alternate Phone Number:
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