Presbyterian Youth Triennium Conference
Triennium Participant Information
Page 1 of 4
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:
---------
Mark Brown
Gina Yeager
PYT Admin Presbytery | Heather Leoncini
*Name - First:
*Last:
Middle:
*Badge Name:
*Cell Phone:
*Email:
*Mailing Address:
*City:
*State:
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Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*Zip:
*Role - please choose one:
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Adult Advisor
Caregiver
Global Partner Adult
Global Partner Youth
Guest Observer
PYT Staff/Volunteer
Work Crew
Youth Participant
*Birthdate:
*Age at the time of Triennium:
*Gender:
(Select all that apply)
Female
Male
Non-Binary
Self-Identify
If Self-Identify, please describe:
*Race:
(Select all that apply)
Native American/American Indian/Alaska Native
Asian
Black/African American
Hispanic/Latino
Native Hawaiian or Other Pacific Islander
Middle Eastern
White
Other
If Other, please identify:
*Pronoun:
(Select all that apply)
He/Him
She/Her
They/Them
Self-Identify
If Self-Identify, please describe:
*T-Shirt Size - please choose one:
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Small
Medium
Large
XL
XXL
XXXL
4X
Dietary Needs:
(Select all that apply)
Vegetarian
Vegan
Pescatarian
Dairy-Free
Egg-Free
Severe Dairy Allergy
Severe Egg Allergy
Severe Gluten Allergy
Severe Wheat Allergy
Severe Soy Allergy
Severe Sesame Allergy
Severe Peanut Allergy
Severe Tree Nut Allergy
Severe Shellfish Allergy
Severe Fish Allergy
Other
Gluten-Free
If Other, please identify:
Group Preferences:
*First:
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Activism
Anti-Racism
Communal Singing & Matthew 25
Community Gospel
Enneagram
Environmental Justice & Faith
Eradicating Poverty/Passion & Social Justice
Experiential Discipleship
GODSPELL – Gospel of Matthew Through Film & Revolution
Hunger, Poverty, Justice
Kindness, Justice, Faith
Leadership
Poetry
Poverty, Racism
Presbyterian Peacemaking – Violence/Peace
Small Group
Spiritual Practice
Trouble The Waters/Disaster, Poverty, Racism
*Second:
---------
Activism
Anti-Racism
Communal Singing & Matthew 25
Community Gospel
Enneagram
Environmental Justice & Faith
Eradicating Poverty/Passion & Social Justice
Experiential Discipleship
GODSPELL – Gospel of Matthew Through Film & Revolution
Hunger, Poverty, Justice
Kindness, Justice, Faith
Leadership
Poetry
Poverty, Racism
Presbyterian Peacemaking – Violence/Peace
Small Group
Spiritual Practice
Trouble The Waters/Disaster, Poverty, Racism
*Third:
---------
Activism
Anti-Racism
Communal Singing & Matthew 25
Community Gospel
Enneagram
Environmental Justice & Faith
Eradicating Poverty/Passion & Social Justice
Experiential Discipleship
GODSPELL – Gospel of Matthew Through Film & Revolution
Hunger, Poverty, Justice
Kindness, Justice, Faith
Leadership
Poetry
Poverty, Racism
Presbyterian Peacemaking – Violence/Peace
Small Group
Spiritual Practice
Trouble The Waters/Disaster, Poverty, Racism