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Bike Trip for Rising 9th-12th grade youth on Saturday, July 11, 2020 @ 5:30 AM

If you would like to pay only the $100 deposit with your registration, please notice the drop down arrow in the price box (above) that shows the full price of $649. Click on the drop down arrow until $100 shows. Select $100 by clicking on it and proceed with registration. You may go back and change your selection, if wished.
If you are requesting scholarship assistance, do not complete this form at this time. Email your request to mleduc@4thpres.org, and you will be notified as to the amount of financial assistance that will be offered, along with registration instructions.
*Name of Youth (Last, First):
*Grade in Fall 2020:
*Name of Fall School:
Please list any Medical/allergy concerns:
Please list any medicines, including Epipens:
*Parental email:
*T-Shirt size:
I am aware that a bike trip waiver must be completed by a parent, as well as one medical authorization form. If the youth attended summer camp 2020, I already have a medical authorization form on file and it is good through May 2021. Links to these forms will be sent to me in the parental email provided.:
While there is no guarantee that we will be able to honor roommate preferences, please feel free to list up to 3 names.:
3 roommates: