Youth Advance / Registration / Registration

Register for Youth Advance by filling out the information below:

Location

First Name

Last Name

Gender

Male

Female

Grade

Age

Your contact info:

Email Address

Home Phone

Cell Phone

Please enter your full address:

Street Address

City

State

Zip Code

T-Shirt Size

Small

Medium

Large

X-Large

X X-Large

Home Congregation

Youth Leader

Youth Leader Email

Youth Leader Phone

Parent/Gardian First Name

Parent/Gardian Last Name

Parent/Gardian Cell Phone

Parent/Gardian Email

Emergency Contact Name

Emergency Contact Phone

Youth Advance begins on Friday morning (registration is from 10:00AM to 11:00AM). This necessitates that each Ambassador will miss a day of school. Do you need Youth Advance to write a letter to your

principal requesting an excused absence for Friday?

Excused Absence Letter?

Yes

No

If Yes, then complete the next four fields.

Principal's Name (Mr., Mrs., Ms., Dr.)

School Name

School Phone

School Address

School City

School State

School Zip

Are you currently taking medications?

Yes

No

Medication details

Are you allergic to any medications?

Yes

No

Allergy details

How will payment be submitted?

If Other was selected as the payment type, please explain:

Event Registration