PYT Participant Information Form Participants should complete this form, review the Community Life Guidelines, and give to registrar. Delegation Name (Presbytery or Church Name usually):___________________________________________________ Participant Name: Last________________________________________________________________________________________ First_______________________________________, Middle_______________________________ (Not used on name badge) Name to appear on Name Badge: ___________________________________________________________________________ Date of Birth: _______________________________________ Gender: M or F Please check one – Participant Role: Adult Advisor____, Youth____, Work Crew____, Caregiver____ Global Partner ___________ Ethnicity (for statistical purposes): _____ African American _____ Asian _____ Caucasian _____ Hispanic _____ Native American _____ Other: _____________ Participant Cell Phone #:_______________________________________, Email______________________________________________________________ Participant Home Address: _________________________________________________________________________________________________________ City______________________________________, State__________, Zip___________________ For Youth Participants: Age as of July 19, 2016: _____________ Entering Grade:__________________ Parent/Guardian Information: Name: _______________________________________________________________________________________________________ Parent Cell Phone: (______)_____________________ Home Phone: (______)______________________ Work Phone: (______)_________________________ Preferred Roommate:______________________________________________________participant preference Assigned Roommate:_______________________________________________assigned by registrar PYT Choir Participation: If you would like to participate in the Triennium choir check one: Soprano:_____, Alto:_____, Tenor____, Bass____ T-­‐Shirt Size: S M L XL XXL XXXL 4X Special Needs: (Please Check All that Apply) _____ Wheelchair or Motorized Chair _____ Diabetic _____ Celiac Disease _____ Vegetarian/Vegan _____ Asthmatic (serious consistent) _____ Other Needs Not Listed? ______________________________________________________________________________ Does this participant have any circumstances, issues, or other important life circumstances that might impact her/his enjoyment, engagement in or experience at the Triennium?