LOOK! High School Youth Day of Service

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Complete the information below to sign up for our LOOK! High School Youth Day of Service in Greenville, SC on July 22, 2021. We will serve our neighbors at various agencies in Greenville and enjoy some fun activities as well. This day is designed to practice "looking" around us at the needs of others - come serve and grow in faith!

Registration will close June 20, 2021.

First Name *

Last Name *

Date of Birth *

Completed Grade *

Parent/Guardian Name & Home Address *

Home Phone Number *

Mother's Cell Phone

Mother's Work Phone

Father's Cell Phone

Father's Work Phone

Emergency Contact (in case parents cannot be reached) - needed only if you have not filled out the 2021 health form

Include Name, Relationship and Phone number

Doctor's Name and Phone Number - needed only if you have not filled out the 2021 health form

Dentist's Name and Phone Number - needed only if you have not filled out the 2021 health form

Medical Insurance Company - needed only if you have not filled out the 2021 health form

Medical Policy Number - needed only if you have not filled out the 2021 health form

Corrective Lenses? - needed only if you have not filled out the 2021 health form

Check all that apply

Glasses

Contacts

Allergies or dietary restrictions? If so, please explain *

List any medical conditions or special needs - needed only if you have not filled out the 2021 health form

physical, learning, behavioral or other

List any medications your child will take during the trip and how they are to be administered

Any other information that will be helpful to know as we travel with your youth?

Submit

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