Game Registration Form

July 22-26, 2009 Registration Form Name:

__________________________________________________________________

Address:

__________________________________________________________________

City, Zip:

__________________________________________________________________

Participant Date of Birth: _____________________ Current Grade Level: _____________________ Phone: ___________________________ Parent Email: ____________________________________ Cell Phone: ________________________Participant Email: ________________________________ Amount Paid: $_____________ Church Group: __________________________________________

Total cost for Youth participants is $50.00 and includes meals, lodging, and t-shirt. The balance will be due by July 1, 2009. Make checks payable to G.A.M.E.

T-Shirt Size: XXL _____ XL _____ L _____ M _____S _____

I grant permission for pictures of my student or myself participating in the G.A.M.E. event to be taken and possibly posted on the one of our church websites or future G.A.M.E. advertisements. (Parent signature)