Pacific Youth Leadership Forum 2003 Home Page
U.S. Army Installation Management Agency

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.

   

First name:
Middle Initial:
Last name:
Name you prefer to be called:
Date of Birth: month day year
Gender: male female
Age:
Grade Level:
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
 
Address 1:
Address 2:
Address 3:
City:
State:
Zip Code:
Parent or Guardians Name:
  Home Phone:
  Work Phone:
  Cell Phone/Pager:
Installation:
Email Address:
Specify any special needs or medical considerations:
Specify any special physical accommodations needed for housing or training
Individual that can be contacted in case of an emergency (first)
  Relationship:
  Home Phone:
  Work Phone:
  Cell Phone/Pager
Individual that can be contacted in case of an emergency (second)
  Relationship:
  Home Phone:
  Work Phone:
  Cell Phone/Pager: