Universal Permission First Spanish Assembly of God
CONVENTION CENTER
9800 INTERNATIONAL DRIVE
ORLANDO, FL 32819
JULY 29–AUGUST 5, 2019
Email address *
YOUTH INFORMATION:
Name *
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Grade *
Gender *
Nickname
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School Name *
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Primary Address *
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Secondary Address
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Youth Email *
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Youth Home Phone
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Youth Cell Phone *
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PARENT GUARDIAN INFORMATION
Name(s) *
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Email(s) *
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List all phone numbers where the parent/guardian can be reached (type: i.e. home, cell)
Contact #1 Name and Phone Number *
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Contact #2 Name and Phone Number *
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Contact #3 Name and Phone Number
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EMERGENCY CONTACT
Name, Phone Number and Relation *
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Name, Phone Number and Relation *
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