Be Real Teen-Led Conference Registration Form
Staff/ Volunteer Info
Volunteer Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Gender (at birth)
*
Male
Female
Participant's Type of Registration
*
Please Select
Volunteer
Staff
Home Church
*
Please Select
Blue Ridge Church of Christ
Capital Collective (DC)
Capital Rivers Church
DC Regional Christian Church
The Delaware Church
Hampton Roads Church
Lehigh Valley Church
Lynchburg Valley Church
Mountain Rock Church of Christ
New River Valley Church
Northern Virginia Church of Christ
Greater Baltimore Church of Christ
Greater Pittsburgh Church of Christ
Greater Philadelphia Church of Christ
Potomac Valley Church
Greater Richmond Church of Christ
Nittany Valley Church of Christ
Other
Would you like to purchase a T-Shirt?
*
Please Select
Yes
No
Baptism Date
*
MM/YY
Have you ever been convicted or pleaded guilty to a crime?
*
Yes
No
Have you ever abused or molested a child? If status is unclear, seek legal counsel
*
Yes
No
Have you been disciplined for any work involving children?
*
Yes
No
Is there any other matter that may disqualify you for service in the Youth Ministry or require that your service be restricted toolder children (health concerns, etc.)?
*
Yes
No
If you answered yes to any of the above questions, please explain here.
*
If you answered no, please write NA.
Have you had a background check by your home church in the last year?
*
Yes
No
Unsure
I understand and agree that as a requirement of serving as a volunteer at this conference that the organizers will run a background check on me or my home church will submit written proof of a background check within the past year.
*
Yes
No
I acknowledge that my picture and/or video image may be taken during the conference and consent to having my likeness used in church promotional or media publications (such as social media posts, newsletters, YouTube videos)
*
Yes
No
Teen-Led Conference Registration
*
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Adult Volunteer Registration
$57.00
$
57.00
Quantity
1
Staff Registration
$165.00
$
165.00
Quantity
1
2
3
4
5
6
7
8
9
10
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Signature certifying that I understand the above conditions and all the information is correct to the best of my knowledge.
*
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