Summer 2024 - Worksite Groups Form

Your Full Name*

First NameLast Name

Your Email*

example@example.com

Preferred Phone Number*

Area CodePhone Number

Church Name*

IMPORTANT INSTRUCTIONS
1. Please use this form to break your youth group into worksite groups. Each group you create will be paired with another church to form a complete worksite team.
2. Pay special attention to the leader and student labels. If you have less than 5 students in any group, leave extra cells blank. If you have less groups than listed, leave extra columns blank.
3. Groups must have no more than 6 participants, including students and leaders, unless special permission has been granted to have additional participants in said group.
4. Each group needs its own transportation and drivers (e.g. if your church has two groups, each with 5 participants, you should not rely on one large van and one driver, but will need two vehicles and two drivers).

Please Enter Participants' Names Below.*

Rows	Group 1	Group 2	Group 3	Group 4	Group 5	Group 6	Group 7	Group 8
LEADER 1
STUDENT 1
STUDENT 2
STUDENT 3
STUDENT 4
STUDENT 5

Do you require and are you requesting permission to add more than 6 people to a group?*

YesNo

Please include the group number, followed by any additional group members' names, in the box below. We will follow up by phone or email to discuss your request.*

Comments or questions?

My Products

Non-Refundable Deposit: Summer Outreach Week$50.00

Deposit Type	Number of Reserved Spots	Price
Student		$50.00
Leader		$0.00
Student: Hartford Resident		$25.00
Leader: Hartford Resident		$0.00

Item subtotal:$0.00

Total $0.00

Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info

Summer 2025 - Worksite Groups Form