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Individual Registration YouthWave 2020
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* Indicates required question
Email
*
Your email
Location
*
SanFrancisco/Bay Area
NewJersey/NewYork
Korea(Republic)
Other
If you clicked others please tell us residing location (State/Country)
Your answer
Your Full Name (First, Last)
*
(First Last)
Your answer
Are you... (please click only one)
Youth Student
Pastor
Small Group Leader
Conference Staff
Gender
*
Male
Female
Date of Birth (MM/DD/YY)
*
Your answer
Your Phone Number (If you have one)
Your answer
If you are youth student, Grade (based Fall 2020)
*
6
7
8
9
10
11
12
I am not a youth student
T-Shirt Size
*
XS
S
M
L
XL
Name of the School Currently Attending
*
Your answer
Church currently attending
*
Your answer
Mailing Address including zip code
*
Your answer
Please list a parent/guardian name and emergency contact number
*
Name (Relationship), Phone Number (at least 2)
Your answer
Photo and video release form
Signature of the parent/Guardian
*
I understand that by checking the box below, I agree and give my signature to all statements above
Parent/Guardian Signature to all statements above (e-signature)
Required
Date of the signature
*
MM/DD/YYYY
Your answer
Send me a copy of my responses.
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