Participant Information
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I am currently a...
Freshman
Sophomore
Junior
Senior
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Last Name
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First Name
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Sex
M
F
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tshirt
small
medium
large
xlarge
xxlarge
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DOB (MM/DD/YYYY)
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School
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Teen's Cell (913.888.7777)
Household / Adult Primary Contact
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Mom's Name
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Dad's Name
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Address 1
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City
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State
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Zip
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Phone (i.e. 913.888.7777)
Emergency/Cell Phone
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Home Parish
Updates will be sent via email.
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Parent's Email Address
Teen's Email
Preferences
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Which day(s) of the week could you meet with a small group?
Monday
Tuesday
Wednesday
Thursday
Is there a friend you'd like to be paired in a small group with? If, so type their first and last name in the space provided.
Are you interested in becoming a student leader? (For Juniors and Seniors only)
Yes
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Indicates Response Required