CONVIVIO Pre-Registration

Participant Information

Welcome to Pre-Registration for CONVIVIO!

In order to process your registration, we ask you to provide the following information.

Please note that all fields marked with an asterisk (*) are required.

If you are a high school student, you will be able to complete the first part yourself but your parent or court appointed legal guardian must complete the second part.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

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4. Participant's Cell Phone: *This question is required.

5. Participant's Email *This question is required. This question requires a valid email address.

6. Do you belong to a youth group?

7. If yes, to which youth group?

7. Have you attended CONVIVIO before?

8. If yes, how many times? This question requires a valid number format.

9. Name of the person who invited you to CONVIVIO: