Trek 2014 Pre-Registration

Please read all the instructions.

In addition to this online form Parents/Gaurdians will need to sign the Church's Permission & Medical Release Form and turn it in to your ward trek specialist.

---

* Required

Personal Information
First Name *
This is a required question
Last Name *
This is a required question
Age *
How old will you be August 1st 2014?
• 12
• 13
• 14
• 15
• 16
• 17
• 18
• Adult
• Other:
This is a required question
Gender *
• Male
• Female
This is a required question
Ward *
If you a not a member of the Pasco Stake, select "Friend/Other"
P2/P5 P3 P4 P6 P8 SR Friend/Other
This is a required question

Contact Info
Primary Phone Number *
xxx-xxx-xxxx
This is a required question
Secondary Phone Number
xxx-xxx-xxxx
This is a required question
Email Address *
Must be a valid email address
This is a required question

Non-member Instructions
If you are a not a member of the Pasco Stake, please provide the name of your friend you will be accompanying below.
Friend Name
This is a required question

Assignment (Adults)
• Ma / Pa
• Captain
• Other:
This is a required question

Medical

IMPORTANT: Parents/Gaurdians will need to sign the Church's Permission & Medical Release Form and turn it in to your ward trek specialist In addition to this online form.
Check any that apply. *
If yes, explain below in the appropriate text field.
• Special diet
• Allergies
• Medication
• Chronic/recurring illness
• Surgery or a serious illness in the past year
• Physical conditions that limit activity
• None of the Above
This is a required question
Special diet
This is a required question
Allergies
This is a required question
Medication
This is a required question
Chronic/recurring illness
This is a required question
Surgery or a serious illness in the past year
This is a required question
Physical conditions that limit activity
This is a required question

Powered by

This content is neither created nor endorsed by Google.
Report Abuse - Terms of Service - Additional Terms