ELCA Youth Gathering Sign Up

Youth's Name*
First Last
Birthdate*
MM slash DD slash YYYY
Youth's Email
Youth's Cell Phone
This will be used to keep in contact before and during the trip.
Address*
Street Address Address Line 2 City State ZIP Code
Gender
- Male
- Female
- Non-Binary
- Other
Racial and/or Ethnic Identity
- African Descent or Black
- Asian or Pacific Islander
- Arab or Middle Eastern
- Multiracial/Multi-ethnic
- American Indian, Alaska Native
- Latino/a
- European American or White
Special Needs (check all that apply)
- I have sensory processing disability that makes me sensitive to light
- I have sensory processing disability that makes me sensitive to sound
- For the purpose of Service Project, I am medically prohibited from prolonged exposure to sun or heat
- For the purpose of Service Project, I am medically prohibited from handling certain food products
- For the purpose of Service Project, I am medically prohibited from being around animal allergens
T-shirt size*
- Adult Small
- Adult Medium
- Adult Large
- Adult X-Large
- Adult XX-Large
Allergies or medical information
Please list any info that may be helpful for the adult chaperones to know.
Parent/Guardian Name*
First Last
Parent's Email*
Parent's Phone*
This number will be used in case of emergency.