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Eastmont Student Ministrys

Whitewater Trip

Eastmont Student Ministrys

Whitewater Trip

July 20-22, 2012

July 20-22, 2012

Name __________________________________ Age _________

Name __________________________________ Age _________

Address _______________________________________________

Address _______________________________________________

City __________________________ Zip ___________________

City __________________________ Zip ___________________

Home Phone _________________Cell phone _______________

Home Phone _________________Cell phone _______________

Grade completed ______________

Grade completed ______________

Guy

Girl

Guy

Girl

Rooming buddy _______________________________________

Rooming buddy _______________________________________

Shirt Size (circle)

Shirt Size (circle)

small

medium

large

X Large

2-X

3-X

small

medium

large

X Large

2-X

3-X

Please return this form with $40 to the check in desk in


youth hall.

Please return this form with $40 to the check in desk in


youth hall.

Registration Due May 27

Registration Due May 27

Remaining balance of $40 or $70 due by July 15

Remaining balance of $40 or $70 due by July 15

**If paying by Check please make Check Payable to


Eastmont Baptist Church and put Students Name on the Memo
line**

**If paying by Check please make Check Payable to


Eastmont Baptist Church and put Students Name on the Memo
line**

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