Adventure 910 Registration Form 2018 - 2019
Cost for Adventure 910 is $50 for students in 9th grade and $25 for students in 10th grade (max of $100 per family). Confirmation for students in 10th grade will be Fall of 2018 with date to be determined. Please make checks payable to Peace Lutheran and note in memo line child/children names. Financial assistance is available upon request. Please fill out a separate registration form for each child. Thank you!
Child's Name *
Your answer
Grade in School in 2018 *
Birth Date *
MM
/
DD
/
YYYY
Student Cell Phone
Your answer
Student Email
Your answer
Name of Parent(s) *
Your answer
Parent Email Address *
Your answer
Parent Cell Phone *
Your answer
Home/Mailing Address *
Your answer
Please list allergies:
Your answer
Health Concerns/Special Instructions *
Your answer
I authorize my child to participate in all Adventure 910 related activities. *
My child's photo can be used on Peace's website and Facebook page. (Please note that photos of kids will be taken during youth activities, but if you answer "no", the pics will not be used for promotional purposes.)
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