Middle School April 16 Religious School Class

We are having class in person on April 16 from 6:30pm-8:00pm, outside at the UH pavilion, fire-pit and outdoor chapel.

There will be physical distancing, masks, and dinner.

* Participant's Full Name

Enter the Student's name.

Sibling(s) Name

Enter the Student's name, if in 6, 7 or 8th

Student Attendance

	Excited to be there
	Sad to miss out

Grade

Sixth
Seventh
Eighth

Parent or Guardian Name

P/G Emergency Contact Phone

Special Considerations

Let us know about allergies, medical conditions, special needs, or anything else the UH youth staff should be made aware to help ensure a successful event for the participant.

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total: