Triennium Participant Information

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This is the PYT Participant Release Form. Everyone who attends PYT must complete this form. Youth participants under the age of 18 must have a Parent/Guardian complete the Parent/Guardian sections of this form.

* Indicates required information

Delegation/Name:

*Name - First:		*Last:		Middle:
*Badge Name:		*Cell Phone:		*Email:

*Mailing Address:
*City:		*State:		*Zip:

*Role - please choose one:

*Birthdate:		*Age at the time of Triennium:
*Gender: (Select all that apply)		If Self-Identify, please describe:
*Race: (Select all that apply)		If Other, please identify:
*Pronoun: (Select all that apply)		If Self-Identify, please describe:

*T-Shirt Size - please choose one:

Dietary Needs: (Select all that apply)		If Other, please identify:

Group Preferences:
	*First:
	*Second:
	*Third: