Cimarron Presbytery - Triennium Registration

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Participant First Name

*

Participant Last Name

*

Participant Email (if applicable)

Participant Address

*

Participant Preferred Phone

*

Name to appear on Name Badge:

*

Participant Role

*

Please select all that apply.

Youth (Entering Freshman-Graduating Seniors) Adult Advisor Work Crew

Participant Date of Birth

*

Identified Gender

*

Please select all that apply.

Female Male

Ethnicity (for statistical purposes)

Please select one option.

African American Asian Caucasian Hispanic Native American Other

Special Needs (please choose all that apply)

Please select one option.

Wheelchair or Motorized Chair Diabetes Celiac Disease Vegetarian Vegan Asthmatic

Other needs not listed?

Does this participant have any circumstances, issues, or other important life circumstances that might impact their enjoyment, engagement in, or experience at Triennium?

Church Name

*

Church City

*

T-Shirt Size (all adult sizes)

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Small Medium Large X-Large XXL XXXL

Youth Participants Only:

Youth Participants: Age as of July 15, 2019:

Please select all that apply.

13 14 15 16 17 18 19

Entering Grade:

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9th 10th 11th 12th Graduated/Completed High School Spring 2019

Parent/Guardian Name

*

Parent/Guardian Primary Phone

*

Parent/Guardian Alternate Phone

Parent/Guardian Email (please include an email in which Triennium staff and presbytery registrar can communicate with you directly):

*

Description

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