Jesus Cares 1st Annual Youth Summit
Last Registration Day - July 31st, 2024
Attendee Information
Please fill in name and contact information of attendee.
Attendee Name
*
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Will your parent or guardian attend the event with you?
*
Yes
No
Parent or Guardian Name
*
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Please let us know if Attendee has any Food Allergies or Health Concerns.
*
Emergency Contact
*
Please enter a valid phone number.
Emergency Contact Name
*
First Name
Last Name
**********************************MEDIA AND PHOTO RELEASE AGREEMENT************************* At this event, we will be taking photos and videos. I agree to the media and photo
*
YES, I DO AGREE.
NO, I DO NOT AGREE
Attendee Signature OR IF UNDER 18, Parent or Guardian Signature
*
MY SIGNATURE HERE GIVES THE ATTENDEE PERMISSION TO TAKE PART IN THIS JESUS CARES EVENT. -------------------------------------------------------------------- PLEASE PRINT NAME BELOW!
Please PRINT NAME HERE
*
Date of Signature
*
-
Month
-
Day
Year
Date
Submit
Submit
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