Westby Coon Prairie and Vang 2020 High School Youth Mission Trip Registration Form
Address (Street, City, State, Zip)
Mobile Phone Number
High School Grade 2019-2020 School Year
Parent Mobile Phone
A $50.00 deposit is required to hold your spot on the trip. After October 20, 2019, this deposit in non - refundable.
Pay by Check/Cash
Pay via Debit/Credit Card or EFT
I request a scholarship
While there are fundraising opportunities available and the church will help with the cost of the trip, the remaining balance of the trip is ultimately your responsibility. If you need assistance, please talk with Pastor Dan. I understand that this balance is my responsibility even if I have to withdraw from the trip.
Yes - I agree
No - I don't agree
Student - By typing my name and current date, I am signing this form and registering for the trip.
Parent - By typing my name and current date, I am signing this form and registering my son or daughter for the trip.
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