Youth & Teen Program

 

Registration Form

You-Teen Program

May 5-6, 2012 (Saturday:     10 am - 5 pm; Sunday:          9.30 am - 5 pm

St. Alphonsa Syro-Malabar Church Los Angeles

607 4^th Street, San Fernando, CA 91340

AGE GROUP: Thirteen >>Twenty (Nobody below 13 will be admitted)

REGISTRATION: Fees - $50.

Maximum number of attendees: 30.

Food  will be served.

First Name ………………………………………………………..

Last Name ………………………………………………………..

Date of Birth ………………………………………………………..

Parents ………………………………………………………..

Address ………………………………………………………..

Phone number to be contacted in case of emergency …………………….

Your Parish/Mission ………………………………………………………..

Parent’s Consent

I ……………………….……………………………………………………, father/mother of…………………..………………………………………………

give wholehearted consent to his/her attending the program. 

I will arrange transportation to him/her.

Signature

Date