Life Guardians Registration

Student Information

Student First Name(Required)

Student Last Name(Required)

Grade in School(Required)

Freshman

Sophomore

Junior

Senior

Fall of 2023

Student Cell Phone

Student Email Address

Would your student like to receive regular email updates from Right to Life?(Required)

Yes

Student Home church

Student's Youth Pastor Name and Contact Info (or pastor if you do not have a youth pastor)

Please include email and phone number.

Student T-shirt Size (Adult Sizes)(Required)

Emergency Contact Name and Phone Number(Required)

List any dietary restrictions

Parent Information, Release Form, and Billing Information

Parent First Name(Required)

Parent Last Name(Required)

Parent Email Address(Required)

Photo Release(Required)

Yes

Allows Right to Life of North Central Indiana to use photos taken during the event for marketing purposes.

Release Form

Parent's first, middle initial, and last name(Required)

Parent "Signature" - By signing, I acknowledge that I am the parent or legal guardian of the above student and that I give him/her permission to attend the Life Guardians Training on Saturday, February 17, 2024 at The Hub 1200 Kings Hwy Winona Lake, IN 46590 I have read and understand the description of this event and I release Right to Life of North Central Indiana and all other sponsors and staff from any liability resulting from illness or injury.

Payment Information

Once you click 'Charge My Credit Card' your credit card will be charged.

Cost

Price:

Billing First Name(Required)

Billing Last Name(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Payment Method*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Total Registration

Name

This field is for validation purposes and should be left unchanged.

Student Information

Parent Information, Release Form, and Billing Information

Release Form

Payment Information

Mailing Address

Email/Phone

Office Location/Hours