Arizona National Guard
                                                    2008 Youth Symposium
                                                                "Life Is A Highway"
                                                        August 22-24, 2008

                                                 Youth Registration Form

Please Complete this form and all other required forms and waivers, LISTED ON THE CHECKLIST BELOW, and submit a hard copy to
                                                             State Family Programs Office. 

Mail:   AZNG State Family Programs Office
            ATTN: 2008 State Family Programs Workshop                                   Fax: 602-629-4483
            5636 E. McDowell Road                                                                     Scan & Email:  Jennifer.Lopez@us.army.mil
            Phoenix, Arizona 85008
                                                                                           
                                                                       ** This form Must be received by 13 August 2008**                                      

                                              

Name of Youth   Name for Name Badge

Age (years)   Grade   Sex  Male Female        Date of Birth 00/00/0000

Parents Name

Address City State Zip Code
              (000) 000-0000
Phone #   Youth E-mail Address

Does anyone other the parents(s) listed have permission to pick the youth up?
Yes No     If YES, Who?

                                                   Youth's Health Information

Does the youth suffer from any allergies, require any medication?  Yes  No
If YES, please explain

 
Does your youth have any special needs (includes ADHD, Autism, etc.)?  Yes  No
If YES, please explain

Does the Youth have an interest in being a part of the National Guard Youth Advisory Board? 
Yes  No

NOTE: Please complete one form per youth attending.  All youth must be a DEERS registered dependent
of an AZNG service member.

A. Garcia/IT
Copyright © 2003 [AZNG Family Programs]. All rights reserved.
Revised: 08/06/08