PRETEEN MISSION TRIP Registration

Thank you for registering your child! We will be staying at The Table (formerly Joliet First) and completing service projects at MorningStar Mission in Joliet. Please submit payment ($40 per student) to the Mission Trip contact person at your church. If you have any questions, please email Lynne Utter at uttermission@gmail.com.

Student Name

First Name

Last Name

Student Date of Birth

Student Grade

Student Home Church

Please include the name of the city the church is in

Student's Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student Allergies

List "none" if there are no allergies.

Student Medication

Please list any medication the student is taking. If none, please list "none."

Student Shirt Size

Parent Name

Parent Email

Parent Phone Number

(###)

###

####

Emergency Contact (if parent cannot be reached)

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####