Meridian South Stake Trek

Get registered to be a chaperone

Chaperone Information

You must receive prior approval from a member of the Stake Presidency of the Meridian South Stake.

First Name *

Last Name *

Your Email *

Stake *

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Ward *

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Your Home Phone

Your Cell Phone/SMS *

Gender * FemaleMale

Emergency Contact Information

Emergency Contact (1)

Name *

Cell Phone/SMS *

Other Phone *

Email *

Relationship to you *

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Emergency Contact (2)

Name *

Cell Phone/SMS *

Other Phone *

Email *

Relationship to you

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Additional Information

Special Diet

Do you have a special diet?

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If Yes, Please give details *

Allergies

Do you have any allergies?

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If Yes, Please give details *

Physical Limitation

Do you have any physical Limitation?

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If Yes, Please give details *

Anything Else?

Is there anything else you would like to add?

Other

Which of the following apply to you : I have professional medical experience
I am participating as a Ma/Pa
I am on the Trek Communication Committee
I am on the Trek Logistics Committee
I am on the Trek Food Committee
I am on the Trek Activities Committee
I am on the Trek Vignettes Committee
I am on the Trek Photography / Videography Team
I am on the Trek Medical Team
I am a member of the Stake Presidency
I am a member of the Stake YM Leadership
I am a member of the Stake YW Leadership
I am a member of the Bishopric
I'm comfortable providing food that meets my needs during the Trek experience

Security Question and Answer

Important! You will use this information to access your registration if you need to make changes or provide additional information at a later date.

Question *

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Answer *