Youth Prayer event Registration Form

IGNITE Youth Prayer Conference Registration Form
Youth Prayer Event

January 3rd - January 4th, 2025

The event will be at Oklahoma Weslyan University in Bartlesville, OK.

Cost is $25 if registered by November 30th, 2024.

Early Bird Registration will close Sunday, November 30th, 2024.

Late Registration Cost is $50.

Late Registration will close December 15th, 2024.

Free Lodging is available at First Wesleyan Church in Bartlesville, OK.

Optional Mens OKWU Basketball game on Saturday, January 4th at 3pm (Entry Fee covered by OKWU).

YOUTH WILL NEED TO BRING THE FOLLOWING:

Sleeping Bag and Pillow

Toiletries (No showers are available at First Wesleyan)

Bible and Notebook

Change of Clothes

Any Medications Needed

Money for travel meals and snacks
Registration Information
Are you registering as an Individual Youth Attending, Group Leader, or Volunteer?*
Do you want to register your youth by uploading a spreadsheet?

YesNo
Name*

First NameLast Name
School Grade*
for Incoming A.Y. '12-'13
Phone Number*
Church Name*
Youth Leader of Church*
How many Youth are you bringing to the event with you?*
Are you brining any additional volunteers?
Please List names of additional volunteers
Birth Date

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact
Emergency Contact*

First NameLast Name
Relationship*
ex. Father, Mother, etc.
Address Of Person To Contact In Case Of Emergency*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number Of Person To Contact In Case Of Emergency*
Please enter a valid phone number.
Insurance Information
Insurance Provider*
Policy Number*
Lodging Information

First Wesleyan Church (Boys and Girls will be separated, showers are not available at the church)
Will you be staying at First Wesleyan Church?*

YesNoOther
Additional Information
Please list any allergies, if no allergies, please enter None:*
Please list any dietary restrictions, if not restrictions, please enter None:*
Please list any medications that you are taking, if no medications, please enter None:*
As the legal parent or guardian of above named youth, I release and hold harmless the Heartland Annual Conference, First Wesleyan Church, Oklahoma Wesleyan University, and the designated sponsors of the Ignite Youth Prayer event as well as any others that volunteer or assist from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of the leaders, or en route to or from any of said premises. I give permission for any photographs or video footage of my child to be used for any and all advertising purposes for the Heartland Annual Conference purposes.*

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IGNITE Youth Prayer Conference Registration Form

Registration Information

Emergency Contact

Insurance Information

Lodging Information

Additional Information

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Youth Leader Registration