Registration for the 2017-2018 Battalion program year. This form is required of all students who wish to participate in Battalion on a weekly basis. 

Student Name *

Student Name

First Name

Last Name

Male Parent or Guardian (if applicable)

Male Parent or Guardian (if applicable)

First Name

Last Name

Female Parent or Guardian (if applicable)

Female Parent or Guardian (if applicable)

First Name

Last Name

Home Address *

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Email *

Student Email (if applicable)

Home Phone

Home Phone

(###)

###

####

Parent Cell Phone *

Parent Cell Phone

(###)

###

####

Student Cell Phone (if applicable)

Student Cell Phone (if applicable)

(###)

###

####

Student Grade Level 6th 7th 8th 9th 10th 11th 12th

Student Date of Birth *

Student Date of Birth

MM

DD

YYYY

Does your student attend church somewhere? * Yes No

If so, where?

Digital Contract *

This will register your student for the current program year. Your signature below gives permission for your student to participate in the Battalion weekly program activities. An event-specific permission form will be sent home for all other scheduled Battalion group activities. Your full name on the line below is considered a digital signature.

Thank you!

Once the form above is submitted please feel free to pay online below or in person when your young man arrives for his first night.

If you need assitance paying the registration fee, please contact Chairman David Droppa at: ddroppa@verizon.net to make arrangements.

Yearly Registrations

20.00

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