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U.S. Army Installation Management Agency

PACIFIC YOUTH LEADERSHIP FORUM 2008

June 20-26

2008

Winners' Camp

Oahu, Hawaii

The United States Army

Youth Registration Form

Procedure:

 

    1.    Print out and complete the Code of Conduct form and return to your Youth Services Director by the deadline.

    2.    Print out and complete a Medical Information Form and return to your Youth Services Director by the deadline.

    3.    Complete the below registration form and submit.

Note: Online registration may NOT work on Youth Technology Lab computers with active Cybersitter filtering   

First name:
Middle Initial:
Last name:
Name you prefer to be called:
Email Address:
Date of Birth: month   day     year    
Gender:  male female
Eligibility:
 If Active Duty, parent's estimated DEROS or ETS date:  month       year            
If Reserve or National Guard, parent's activation date:  month       year            
Age:
Grade Level:
Collared Out-brief Shirt Size:

Size

 XS S M L XL 2XL 3XL 4XL
Chest  30-32 34-36 38-40 42-44 46-48 50-52 54-56 57-59
 
   
T-Shirt Size:

Size

 XS S M L XL 2XL 3XL 4XL
   
Address 1:
Address 2:
Address 3:
City:
State:
Zip Code:
Parent or Guardians Name:
  Home Phone:
  Work Phone:
  Cell Phone/Pager:
   Email Address:
Installation/Site
Specify any special needs, dietary requirements or medical considerations:
Specify any special physical accommodations needed for housing or training
Individual that can be contacted in case of an emergency (first) *An individual not used elsewhere on this form.
  Relationship:
  Primary Phone:
  Work Phone:
  Cell Phone/Pager
Individual that can be contacted in case of an emergency (second) *An individual not used elsewhere on this form.
  Relationship:
  Primary Phone:
  Work Phone:
  Cell Phone/Pager:
   

       

Problems with this form? email: registration@paroylf.org