Please REGISTER Below

*Waiver Form (please read and sign below)

Cast Member First Name(required)

Cast Member Last Name(required)

Cast Member Birthday and Age (if 18 or below)

Cast Member email Address (If 18 or below and do not have an email address, write NONE)(required)

Cast Member mobile phone number (if 18 or below and do not have a personal phone, write NONE)(required)

Parent/Guardian First Name (if cast member is 18 or below)

Parent/Guardian Last Name (if cast member is 18 or below)

Parent/Guardian email address (if cast member is 18 or below)

Parent/Guardian Mobile Phone (if cast member is 18 or below)

Home Address(required)

Home Phone - if applicable

Home Church - if applicable

Emergency Contact Info. - Name, Relationship & Phone no.(required)

Additional Comments

Medicine or Food Allergies? (please list)

Cast Member T-Shirt Size(required)

*after pressing Submit, “message sent” will appear, along with a review of your answers.
If not, please check all required areas carefully and submit again. If any problems, please contact Dane Ison (YPAC Director) at dane@enewhope.org

Please REGISTER Below

Like this: