Christmas Concert Trip!

Student Name *

First Name

Last Name

Student Phone Number

If the student does not have a phone number, please leave blank.

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The student listed above is a registered UYC member with all parental permissions approved. Furthermore, the student listed is not suspended from UYC. *

Yes

No

I'm Not Sure

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

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The trip will run from 6:00pm-9:00pm on Tuesday, December 20th. The student will need to find their own way to and from the UYC building. *

OK, I can arrange transportation (walking, driving, biking, etc.) to and from UYC.

Help! I don't have transportation to or from UYC. Please contact me about options.