Youth Rally Adult Registration Form

Youth Rally Individual Adult Registration Form

Name

First Last

Untitled

Address

Street Address Address Line 2 City State ZIP Code

Date of Birth:

Gender:

Parish:

Dietary Needs/Allergies/Medical Restrictions:

I am Safe Environment Compliant and my clearances are on file at my parish/school. Safe Environment Compliance will be verified.

Safe Environment Compliant

Name:

First Last

Relationship to Registrant:

Phone:

Email:

Registration Cost - $25

Price: