Mission Trip NM 2022 Sign-up

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June 18th - June 25th. Cost: $65

Child's Name *

Friend you're attending with:

Question only required if you are not a member of ASM

Grade

Question only required if you are not a member of ASM.

Parent/Guardian Phone #:

List all that apply.

Primary Emergency Contact (Non Parent)

Phone # for Primary Emergency Contact: *

Medication your child is currently taking:

This needs to be turned into Ryan prior to leaving so that he or a volunteer can ensure medication gets taken properly.

Does your child have any allergies I need to be aware of?

Have you filled out the ASM Event/Medical waiver since the Summer of 2021? If no, here is the link: http://adamsyouth.weebly.com/uploads/2/5/9/1/2591702/year_long_asm_event_permission_form_-_word.docx *

Yes

Required

T-Shirt Size *

Small

Medium

Large

X-Large

XX-Large

Required

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