Professional Documents
Culture Documents
Steubenville 2015 Registration - Parish Portion
Steubenville 2015 Registration - Parish Portion
1. PARTICIPANT INFORMATION
Full Name:
School:
(print clearly)
Gender:
F (circle)
Email:
Denomination:
Cell Phone:
Age:
M
Grade:
Parent/Guardian Name
Home:
Cell:
Work:
Email:
Home:
Cell:
Work:
Email:
(print clearly)::
Allergies
Medications:
Physician Name:
Physicians Phone:
YES
I also understand that the deposit and any additional paid fees are non-refundable, but that they are transferable,
meaning that in the event of not being able to attend the conference, my child can find someone else to take up
his/her spot, provided that other person pays all the applicable fees.
Participant:
Signed
Print Name
Date
Signed
Print Name
Date
Signed
Print Name
Date
Parent(s)/Guardian(s):