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Youth
Event Registration Form . Beginning on July
14 all registration will be done via email , phone, or online. To register
call: 912-484-4844 or Email: ginajenk@aol.com with the information below. Fill out the form below and bring it
to the event with cash or a
check payable to: Episcopal
Youth Programs or you may register online using the links on this page. ONLINE
registration is HERE! Event Registering For (circle one): Fall Rally($75) Fall
Explosion($75) Acolyte Festival($45) Winter Blast($75) Spring
Fling($75) Work Weekend($75) Convention
Lock-In($20) Happening
($80) New Beginnings ($80)
Name__________________________________________________________________________________________________ First Last called
by: Address
_____________________________________________________________________________________________ City
_________________________State _________ Zip _________
Phone________-________-__________ Grade
_________ Graduation Year _________
Shirt size:
youth: M L adult: S M L XL XXL Email Address
__________________________________________________ Birth date _______________ Priest /
Pastor __________________________________________________ Confirmed? (circle
one) yes no Parent / Guardian
_________________________________________________________________ Address (if different)
______________________________________________________________ City ________________________State
______ Zip __________ Phone______-______-________ Just a reminder: The Covenant of Community
Guidelines as printed below is followed during all youth events. It is
strictly enforced. Please do not register for an event if living within this
Covenant will not be possible for you throughout the weekend. Applicant: I agree to
abstain from the use of any tobacco products, alcohol, illegal substances, inappropriate
prescription medication, and sexual activity while at an event sponsored by
the Episcopal Diocese of Georgia Youth Programs. I also agree to fully
participate in all activities. Signature
____________________________________________________________ date
________________________ Parent/
Guardian: I give the
above named child for whom I am legally responsible permission to attend the
above named event and sponsored by the Episcopal Diocese of Georgia. I agree
to hold harmless all representatives of the Episcopal Diocese of Georgia in
regard to accident or injury involving the above named child while at the
event. I grant permission for said child to be treated by trained medical
personnel and agree to be responsible for all expenses incurred in the course
of such treatment. Signature
____________________________________________________________ date
_________________________ Insurance
Policy Name and #
__________________________________________________________________________
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Register Now Register online for New Beginnings |
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scopal Diocese of Georgia Youth |
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