Registration Form (6th-12th graders)
Student Registration for the MIX | February 26-28
Name of Student *
Student Grade Level *
Parents Mobile Phone Number *
Parents Email
T-Shirt Size *
Has Student ever had Covid-19 *
If Student has had Covid, what was the date of the positive test?
MM
/
DD
/
YYYY
Is your student currently taking medication, or do they have any health condition we should know about? Allergies? *
I have paid the $50.00 student fee, or have made arrangements with Covenant Youth Pastor. *
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