| *Your Name: |
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| *Student or Adult? |
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| *Name of Event: |
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| Total Cost: |
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| Where will you make payment? |
(online, church office or student registration table) |
| Cash Amount: |
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| Check Amount: |
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Check Number: |
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| Previous Payment: |
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Balance: |
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| T-Shirt Size (if applicable) |
(Youth Large, Adult Small, Adult Medium or Adult Large) |
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* Emergency Numbers:
(please list 2) |
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| *Parent/Adult Email |
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| Student Email |
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| School/Grade |
/
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| Roomate Request |
Student 1:
Student 2:
Student 3:
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| |
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Please include any comments, questions or any specific information here:
(If you would like to apply for a scholarship for this event, please write here the amount you can pay and the amount you need help with.) |
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