Youth Rally

Youth Camp Information & Registration

Name *

First

Last

Age *

Are you a attendee or volunteer? *

Attendee
Volunteer

Sending Church *

Phone *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Confirm Email

$20 Deposit Bank Transfer Receipt / Reference Number *

I (print name) *

Parent/Guardian/Applicant Full Name

being the Parent/Guardian or I am over 18 *

of the above person hereby acknowledge that the above information is correct and that I give permission for my son/daughter/ myself to participate in all the activities and abide by the rules supplied in the registration pack.

Signature *

Clear Signature

Parent/Gurdian Signature of Youth Rally Registration

Date *

Medical and Permission Form

If you have a medical condition that requires a medical plan, please describe it here.

Medical conditions

Emergency Contact 1

Full Name: (Emergency Contact 1. ) *

Relationship with contact 1 *

Phone number of contact 1 *

Address of contact 1

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Contact 2

Full Name: (Emergency Contact 2.)

Relationship with contact 2

Phone number of contact 2

Address of contact 2

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

STEP ONE: To pay $20 registration fee

STEP TWO: To complete the following registration form

Youth Camp Information & Registration

Medical and Permission Form

Media Release Form

Billeting / Accomodation