ALL-YOUTH SERVE & HOUSE PARTY
Saturday, June 15
7:30am-3pm
*Register by Thursday, June 12
STUDENT INFORMATION
Student First Name *
Your answer
Student Last Name *
Your answer
Grade *
Student Cell Phone (optional)
Your answer
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Cell Numbers(s) *
Your answer
Emergency Contact Name and Cell: *
Your answer
Additional Information (i.e. allergies, meds, event specifics)
Your answer
PARENTAL CONSENT
Parental/Guardian Agreement: "By submitting this Registration Form I AGREE that I have given permission for my student to be at the specific youth event for the designated times, under the supervision of the event leaders." *
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