Registration For Immigrant Youth Summer Camp-Out

Name of School/Contact Place(Required)

Name(Required)

First Last

Phone(Required)

Email(Required)

Parents/Guardian Name(Required)

Phone

Would you like to attend the program?(Required)

Yes

Your T-shirt size :

Diet/Allergy Peculiarity

Regular

Vegetarian

Special Dietary Requirements

What do you hope to gain from the program?

I grant permission to the Covenant Information Empowerment Services Inc. to capture my photo and to make recording of my image and voice for use in printed publications, electronic publications, official website and any legal use.(Required)

Yes

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