Weekend for Life
Weekend for Life - Little Rock, AR

Date/Fecha: January 18-19, 2020

Time: Saturday to Sunday
Bus Loads at 1:45 pm on Saturday
Bus Leaves at 2:00pm
Bus Returns Sunday at 6:30pm

Tiempo: Viernes a Domingo
Subida al Camion es alas 1:45 pm el Viernes
Salida del Camion es alas 2:00 pm
Regreso del Camion es ala 6:30 pm el Domingo

Location/Lugar:
Double Tree Hotel
Little Rock, AR

Open to youth in grades 9-12th Grade
Convencion Estatal da la bienvenida a los jovenes en grados del 9-12

$85 Total event cost/costo del evento
Includes: Registration Fee, Transportation, Lodging, Dinner, Breakfast, & Lunch
Incluye: Cuota de registracion, transportacion, estancia, cena, desayuno y almuerzo
First Name *
Primer Nombre
Your answer
Last Name *
Apellido
Your answer
Participant E-mail Address
Correo electronico del participante
Your answer
Grade
Participant Phone Cell Number
No. de cellular del participante
Your answer
Youth or Chaperone/Joven o Guia *
Chaperones must be approved and go through the Volunteer Application Process before the event. Guias deben de ser aprovado y pasar por el proceso de aplicacion para voluntarios antes del evento.
Gender/Genero *
Parent/Guardian Name; Nombre del Pariente/Guardian *
Spouse or Emergency Contact if you are an Adult Volunteer. Nombre del contacto del esposo/a o de emergencia si usted es un adulto voluntario.
Your answer
Parent/Guardian Contact Number; Telefonico del Pariente/Guradian *
Spouse or Emergency Contact if you are an Adult Volunteer. No. telefonico del contacto del esposo/a o de emergencia si usted es un adulto voluntario.
Your answer
Parent/Guardian E-mail Address; Correo electronico del Pariente/Guardian
If Adult Volunteer please type your email address here. Si usted es un Adulto Voluntario por favor proporcione su correo electronico.
Your answer
Mailing Address *
Domicilio
Your answer
City *
Ciudad
Your answer
State *
Estado ( Escoja una abreviacion)
Your answer
Zip Code *
Codigo Postal
Your answer
Participant Parish *
Parroquia del Participante
Special Needs (Medications & Medical)
Atenciones especiales necesarias (Medicas y Medicamentos)
Your answer
Parent/Guardian Typed Signature; Firma del Pariente/Guardian *
Typed Name of Legal Parent/Guardian. If Adult Volunteer type your name here. Pariente/Guardian favor de poner su nombre aqui cual contara como su firma. Si es un Adulto Voluntario por favor de poner su nombre aqui.
Your answer
Do You Need Assistance in Paying after the $20 minimum
Rooming Request - 4 to a room (that is you & 3 others)
Solicitud de compartimiento de habitacion - 4 por habitacion
Your answer
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