ValleyView Alliance Church - LIFE 2019 Registration Form

LIFE 2019 Registration Form

Youth 1 Name (As it appears on license or school ID)	*
Youth 1 Grade (Students have to be entering 9th grade in the 2019/20 school year up to and including 2020 high school graduates.)	*
Birth date	*
Age	*
Youth 2 Name (As it appears on license or school ID)
Youth 2 Grade
Birth date
Age
Youth 3 Name (As it appears on license or school ID)
Youth 3 Grade
Birth date
Age
Parent’s Names	*
Address	*
Emergency contact number	*
City	*
Your Email Address	*
I give permission for my son/daughter to attend the LIFE2019 Conference in Orlando, FL on July 9 - 13. I understand that I am responsible for the full cost of the trip and that the $270 deposit is non-refundable.	*
Registration for LIFE 2019	*
If interested in participating in the Momentum 5K, the additional cost will be $35 which will include getting a t-shirt. Please select the t-shirt size. The additional cost of the t-shirt will be added to your account. The sizes are S, M, L, XL, 1X, 2X, 3X.

Total	$