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Student Registration Youth Wave 2021
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* Indicates required question
Email
*
Your email
Name of the Student
*
(First Last)
Your answer
Gender
*
Male
Female
Date of Birth
*
Your answer
T-Shirt Size
*
XS
S
M
L
XL
Name of the School Currently Attending
*
Your answer
Grade of the student
*
Your answer
Church currently attending
*
San Jose Korean Presbyterian Church
Concord Baptist Church
Tri-Valley Presbyterian Church
NewLife Church (Fremont)
Oakland Woori Church (Oakland)
Happy Valley Church
Disciple Church
Crossway Korean Church (Hayward)
Emmanuel Missions Church
Spring Fountain
Silicon Valley Presbyterian Church
Light of Grace Presbyterian Church
Cornerstone Community Church (Redwood City)
Joyful Church (SanRamon)
Other:
Required
If checked "other" please write the name of the church
Your answer
Please list a parent/guardian name and emergency contact number
*
Name (Relationship), Phone Number (at least 2)
Your answer
Allergy to any food/medicine
*
If none, write N/A
Your answer
Name health insurance provider and Policy Number
*
Your answer
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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