Youth Tour Chaperone Form

Chaperone's Full Name*

First Middle Last

Preferred Name*

Cell Phone Number*

Email*

Date of Birth*

T-Shirt Size*

Small
Medium
Large
XL
XXL

Parish*

Gender*

Female
Male

Assigned at birth.

Social Security Number*

For touring purposes. Format ###-##-####

Will you have additional family members traveling with you?*

Yes
No

If yes, please provide the following information. If no, please skip to Emergency Contact Information

Spouse Full Name

First Middle Last

Preferred Name

If your preferred name is your first name, please retype your first name.

Spouse Phone Number

Spouse Email

Spouse Date of Birth

T-shirt size

Child #1 Full Name

First Middle Last

Child #1 Preferred Name

If your preferred name is your first name, please retype your first name.

Child #1 Phone Number

Child #1 Email

Child #1 Date of Birth

Child #1 T-shirt Size

Child #2 Full Name

First Middle Last

Child #2 Preferred Name

If your preferred name is your first name, please retype your first name.

Child #2 Phone Number

Child #2 Email

Child #2 Date of Birth

Child #2 T-shirt Size

Emergency Contact #1*

First Last

Cell Phone Number*

Secondary Phone Number

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact #2 Name

First Last

Cell Phone Number

Secondary Phone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Chaperone Photo*

Accepted file types: jpg, gif, png, Max. file size: 30 MB.

Upload a headshot of yourself for identification purposes.

Guideline Acknowledgment*

Chaperone Acknowledgement

I have read and understand all the guidelines and completed all of the forms.

LA YT Chaperone Form