INDIVIDUAL REGISTRATION FORM

Sunshine Church of Christ Youth Rally

Please fill out one copy of this page for each member of your group.

Date of youth rally___________________________________

Your name _________________________________________________________________

Age______ Sex ______

Group/church you are with_______________________________________________

Name of group's counselor/chaperone ____________________________________________

I have allergies or other special medical needs. (Please specify on medical form)

Other pertinent information:




Assigned to cabin #_________