Three easy steps to register your TEEN:

  1. Parent fill in ALL blanks below
  2. Click the SUBMIT button
  3. Choose form of payment and pay (you’ll be redirected to payment page after submitted registration form below)

As the parent or legal guardian, I give permission for my son/daughter to participate in the Real Connections TEEN EXPERIENCE. Their schedule will allow them to complete the hours as follows:

  • Saturday, July 30th         11:00am – 11:00pm

Registration Form

TEEN Full Name:

TEEN Name on Nametag (first or nickname name):

TEEN Date of Birth (MM/DD/YY):

TEEN Gender:

TEEN Best Phone (w/area code):

TEEN Best Email Address:

TEEN City & Zip coming from:

Mode of Transportation:

Possible Availability to Carpool (yes/no)?:
 Yes No

PARENT/Guardian #1 (First & Last Name):

PARENT/Guardian #1 Phone (w/area code):

PARENT/Guardian #1 Email Address:

PARENT/Guardian #2 (First & Last Name):

PARENT/Guardian #2 Phone (w/area code):

PARENT/Guardian #2 Email Address:

Additional Contact Name & Phone:

How did you hear about us?:

TEEN Food Allergies/Sensitivities:

TEEN Physical/Medical Concerns:
(List any prescription medications and/or special conditions)

TEEN Anything else we should know: