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Youth Tour Student Registration Page

If you are an Alternate and wish to go on the trip as a Willie Wiredhand - click Willie Wiredhand.
(First Name as you want it to appear on your name badge - if you go by a different name other than your given name)
(City and State/or Country of Birth)
If you do not have a home land line - enter N/A
No Spaces (ex: Los Angeles = LosAngeles)

Parent/Guardian Contact Information

Washington Youth Tour -- Emergency Contact -- OTHER THAN PARENT OR GUARDIAN

List the names and telephone numbers of two individuals, OTHER THAN YOUR PARENTS OR GUARDIANS, who can be contacted in case of an emergency - this will be used if staff can not contact your parents or guardians. Staff will try to contact parents or guardians first.
Contact 1
Contact 1
Contact 1
Contact 1
Contact 2
Contact 2
Contact 2
Contact 2

Washington Youth Tour -- Medical Information

List any allergies for which you take medication, or any other medical condition for which medication would be needed for the trip (i.e. diabetes, car sickness, pregnancy, etc.). Also, please list any chronic or temporary medical conditions (such as pregnancy, epilepsy, diabetes, etc.) that the tour director and chaperones should be aware of.
If a new medical condition occurs prior to Youth Tour contact Ashley Graham: or call 217-241-7916.
IF APPLICABLE Do you have any of the following:
If you have a religious dietary restriction please list here

Washington Youth Tour -- Insurance Data

Note: This information is required for the Accidental Insurance Coverage provided by the AIEC for the participant.

** Next Step **

Complete the Student Medical Release via the link provided. Print the Rules and Expectations & Social Media Contract forms. Return them signed by parent(s) or guardian(s) and student to Ashley Graham by May 2, 2022.