Youth Information
Please complete this information form and the medical release that follows to register your child for the St. James's 2018 Youth Trip to Washington D.C.. Permission slips for travel and other aspects of the trip are forthcoming.

DC 2018 is for youth attending high school during the 2017-18 school year. DC 2018 Youth trip will include visits to
popular landmarks including the U.S. Capitol Building, Washington Monument, National Mall, Washington
National Cathedral, and many more. Participation in formation opportunities and fundraising required. Contact Curtis Farr with any questions: associate@stjameswh.org or 860.521.9620 x702

Youth Name *
Your answer
Street Address *
Your answer
Town/City *
Your answer
State & Zip Code *
Your answer
Primary Family Phone *
Your answer
Youth Birth Date *
MM
/
DD
/
YYYY
Youth Age *
Your answer
T-Shirt Size *
Guardian #1 Name and Relationship *
Your answer
Guardian #1 Cell *
Your answer
Guardian #2 Name and Relationship
Your answer
Guardian #2 Cell
Your answer
Other Emergency Contact Name and Relationship *
Your answer
Other Emergency Phone *
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms