Youth Mission Day Adult Registration Youth Mission Day Adult Form First Name* Last Name* Email* Cell Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Church Affiliation*COSFaithGood ShepherdRedeemerSt AgnesSt AlbansSt BonifaceSt CharlesSt DominicSt JamesSt MarySUMCOtherNoneT-Shirt Size* Small Medium Large X-Large XX-Large Crew Leader: One adult will be assigned to each crew Please fill out if you wish to be a Crew Leader. As a Crew Leader you will be driving your crew to your sites. Please bring a full size cooler with ice for your CCOS provided lunches, water & soda. Note: Due to church liability policy, no students or individuals under 21 are permitted to drive for Youth Mission Day.How many youth can you drive in your vehicle?2345678Important for seatbelt count!What type of vehicle? Car Truck SUV Designate if a specific crew/teen assignment is desired: Kitchen Help: Adults are needed to organize, prepare, pick-up, serve meals and help with clean up Please fill out if you wish to be Kitchen Help.Availability Saturday morning to serve breakfast (7:30-9:00am)
