More information on May 4th’s Youth Soul Shop Retreat Chaperone Registration Please enable JavaScript in your browser to complete this form.Have you had a background check completed within the last two years?YesNoAll chaperones are required to have a background check. Name *Email *PhoneChurchRole in ChurchDo you have any alergies or medical needs?AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBirthdayWhich chaperone meeting can you attend?April 21 at 2:00pmApril 25 at 7:00pmAll chaperones are encouraged to attend one of the two chaperone meetings. Both will be on ZoomSubmit Share this