Youth Registration

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

Allergies *

School *

Parent / Guardian Name *

Parent / Guardian Phone Number *

Parent/Guardian email *

Email Address

Choose Event

Riverside Middle Youth (Gr. 5-7) (Riverside Community Church, 2329 Fremont Connector, Port Coquitlam)
Dec 31, 2021 8:00 PM
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Riverside High School Youth (Gr. 8-12) (Riverside Community Church, 2329 Fremont Connector, Port Coquitlam)
Dec 31, 2021 8:00 PM
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