T Zone Student Registration
All students MUST complete this registration.
Church Name *
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Address, City, State, Zip *
Your answer
Gender *
T Shirt Size *
Grade Completed Spring 2018 *
Home Phone *
Your answer
Participant Cell # *
Your answer
Parent/Guardian Name *
Your answer
Daytime Phone *
Your answer
Evening Phone *
Your answer
Parent/Guardian Name 2 *
Your answer
Daytime Phone *
Your answer
Evening Phone *
Your answer
If my parent is not available in an emergency, notify: *
Your answer
Phone Number *
Your answer
Are you a... *
If there are extenuating circumstances preventing you from being there on all days, please indicate here. (These must be approved by your group leader)
Your answer
Health History: Please list any allergies (food, medication, etc), illnesses, diseases or special concerns that T-Zone staff should be aware of.
Your answer
I give permission for my child to be administered the following (select all that apply): *
Required
Date of last tetanus? (You must be current) *
Your answer
I understand that, in addition to this online form, I must also bring a signed release form with me to T Zone. *
Submit
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