El Paso Ministry Trip

Are you registering a leader or student?

Leader/Adult Student

Name

Age (if student)

Birthdate

Grade just completed: 4th 5th 6th 7th 8th

Address

Other Information (e.g., diet needs, allergies,etc.)

Parent/Guardian Information (if you are leader, please add some emergency contact info)

Mom/Guardian 1

This address will receive a confirmation email

Cell Phone

Dad/Guardian 2

Cell

Emergency Contact

Relationship

Cell

Payment Options

Option

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Summer of 2024

Trip Dates: May 30-June4

Medical release forms will be filled out closer to trip. This form is only for basic contact information, reservations and payments.

El Paso Ministry Trip

Description

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