I am registering for (check all that apply): *

Stripling Warrior Camp (July 8-10 for all young men)

Youth Conference (July 24-25 for all youth)

I am a: *

Young Woman

Young Man

Adult

Youth Name *

First Name

Last Name

Youth Birthday *

MM

DD

YYYY

Youth Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Youth Cell Phone (or alternate parent phone) *

(###)

###

####

Parent or Guardian Name *

First Name

Last Name

Parent or Guardian Cell Phone *

(###)

###

####

Ward *

Acton

Keene

Littleton

Lowell 1st or 2nd

Merrimack or Nashua 2nd

Nashua 1st

Peterborough

T-Shirt Size *

Small

Medium

Large

X-Large

XX-Large

XXX-Large

Parent/Guardian Acknowledgement *

I have read, understand, and agree to this release and permission form.