<- Back to DW Info Page Student InfoStudent's Name* First Last Student's Age*Student's Grade*-9th10th11th12thStudent's Gender*-MaleFemaleStudent's School*Student's T-Shirt Size**Adult sizes only-S - SmallM - MediumL - LargeXL - Extra LargeXXL - Double Extra LargeStudent's Cell Phone*Student's Home Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Is student a visitor? Yes If student is a visitor, who were they invited by?*Roommate Request*High school students will spend Friday and Saturday nights at host homes. Indicate below 2 friends that the student would like to be housed alongside. We will make every effort to put students with one of these requests.Will student be leaving at any point during the weekend?(do not check anything if staying the entire weekend) Yes When will the student be leaving?*Please note day and time.When will the student return?*Please note day and time.Does student have any special needs?Parent InfoParent/Guardian (Primary Contact)* First Last Other Parent/Guardian - Name First Last Parent/Guardian - Cell Phone*Other Parent/Guardian - Cell PhoneParent/Guardian Email* Media Release Attention: By submitting this form you thereby give permission for photographs/videos from this event in which your child appears to be used for publications and public relations activities by Riverchase United Methodist Church. This usage may include use in print media, electronic media, and social media. Please email the RSM Youth Staff at info@riverchasestudents.com if you DO NOT wish for photos/videos of your child to be published in church publications.PaymentPayment Options*Credit/Debit Card PaymentScholarship PaymentOptional Scholarship DonationIf you would like to help provide funds for a student scholarship to Discovery Weekend, please insert the amount above. Scholarship CodeIf you would like to request a scholarship please contact Taylor Sallade at TaylorP@riverchaseumc.orgDiscovery Registration Fee Price: $125.00 Discovery Registration Fee Price: $0.00 Total $0.00 To complete registration please submit payment through PayPal.Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
