Corpus Christi Disaster Relief Youth Trip
WHO: Current 8th-12th graders
WHEN: June 8-14, 2018
WHERE: Corpus Christi, TX
COST: $375 total. Down deposit of $150 due at registration to secure spot. Limited spots available
TRIP LEADERS: Rebekah Schumacher, Mike Schumm

Email address *
Youth Name *
Your answer
Emergency Contact (name, relationship, phone number) *
Your answer
Phone Number *
Your answer
Address *
Your answer
School & Grade (current 2017/2018) *
Your answer
I will pay the $150 deposit upon registration. *
Required
Dietary restrictions *
I understand that I will need to participate in all fundraisers and work with the group towards raising $3000 to keep cost at current rate. *
Required
I agree to adhere to the Payment schedule: *
Payment #1: $150 due with registration (last day to register is March 21st). Payment #2: $150 due April 15th. Payment #3: $75 due May 15th.
Required
I understand there will be more forms to fill out for "Heart for Texas" volunteers including a background check for all participants for all ages at a later time. *
Required
I understand that I will need to fill out a background check at this link upon registration: *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Pilgrim. Report Abuse - Terms of Service - Additional Terms