Mission Week Registration

Please fill out this form and click submit.

I am

*

Please select one option.

a student. an adult volunteer.

Name

*

Date of Birth

*

2020-2021 Grade Level (Students only)

Please select one option.

9th 10th 11th 12th College

Email

This address will receive a confirmation email

Phone

*

Mailing Address

*

Allergies/Dietary Restrictions

Emergency Contact Name

*

Emergency Contact Phone 1

*

Emergency Contact Phone 2

Emergency Contact Email

*

This address will receive a confirmation email

T-Shirt Size

*

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Small Medium Large XL 2XL 3XL

Registration Fee $20.00

I understand that photographs and/or video recordings of my child may be made during this event. I authorize the use of such material by St. John Lutheran Church for its purposes.

*

Please select all that apply.

Yes, I authorize.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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Please Fix the Following

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