Christian Education Congress 2025 Registration

Christian Education Congress 2025 Registration

July 16-19, 2025
A separate form must be completed for each registrant.

Youth Registration - $50

Adult Registration - $115
Are you registering an Adult or Youth?*

Adult - Over 26 years old.Youth - Under 26 years old.
Adult Registration Form

Age 27 & up.
Title
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact*

First NameLast Name
Emergency Contact*
Please enter a valid phone number.
Church Name*
Church City*
Church Pastor*
Presiding Elders District*
Group*
Adult T-Shirt Size*

SmallMediumLargeX-Large2X-Large3X-Large
Youth Registration

Age 26 years and under.
Youth Name*

First NameLast Name
Youth Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Youth Home Phone Number *
Please enter a valid phone number.
Youth Date of Birth*

MonthDayYear
Date
Parent / Guardian Name*

First NameLast Name
Parent / Guardian Phone Number*
Please enter a valid phone number.
Parent / Guardian Email*
example@example.com
On-Site Chaperone Name*

First NameLast Name
On-Site Chaperone Phone Number*
Please enter a valid phone number.
On-Site Chaperone E-mail Address*
example@example.com
Church Name*
Church City*
Pastor's Name*
Presiding Elders District*
Group*
Youth T-Shirt Size*

SmallMediumLargeX-Large2X-Large3X-Large
Participant Covenant
Believing that I am a part of the faithful community of the whole people of God at the event, I promise to be responsible for my actions, abide by the Fourth Episcopal District guidelines, and be open in mind and heart to the teachings and leading of the Holy Spirit. I promise to do my part to make the experience for me and others one that is safe, enjoyable, and free from unkindness and insensitivity.

As a conference participant, I promise to participate in the building and caring for a faithful community by:

• Constantly seeking to be a faithful and responsible example for the group at this event.

• Dressing appropriately (not wearing clothing that is too revealing, i.e., short shorts, bikinis, strapless tops or dresses, shirts that allow for a bare midriff, or pants worn below the waistline); I will not bring t-shirts that advertise alcohol, tobacco, or other illegal substances or that contain language/pictures that demean or ridicule someone's gender, sexuality, or ethnic origin.

• Refraining from the use of tobacco products, alcohol, and illegal drugs during this event and while traveling to or from this event.

• Refraining from inappropriate sexual behavior during this event.

• Leaving at home items such as skateboards, scooters, rollerblades, firearms, knives, weapons of any kind, incendiary devices (matches, lighters, fireworks, and so on), laser pointers, or other items that could disrupt the conference or other hotel guests.

• Participating in all scheduled activities and honor all meeting times.

• Abiding by all quiet times or curfews scheduled or announced.

• Swimming in groups (if allowed), at designated times, with an adult chaperone over the age of25 always.

• Respecting the personal belongings and residential spaces of others by not entering any hotel rooms or buildings that are not assigned to me during my stay, to include harm to the buildings, grounds, equipment, or other resources of the hotel or its facilities.

• Respecting the role ofresponsible adults leading or attending the conference or staying at the hotel by maintaining constant communication with my church group leader(s) so that my whereabouts and personal safety are not of concern.

In a community based on love, respect, trust, and support, each participant is responsible for his/her own actions. I also understand that ifl fail to live up to the expectations of this covenant, I may be sent home at the discretion of the event director and at the expense of the participant and/or his or her parents.
Participant Signature*

Clear
Parent Guardian Signature*

Clear
Pastor's Signature*

Clear
Emergency Medical and Release

This area must be completed for every participant under 18 years of age.
Name of Registrant*

First NameLast Name
Health Insurance Provider
Group Policy Number
Family Physician

First NameLast Name
Family Physician Phone Number
Please enter a valid phone number.
Allergies (food, medicine, etc.)
Prescription Medication(s) Required During This Event. (Name, Dosage, Frequency)
Any required medications will be keptin a secure location under the guidance of participants' local church chaperone&youth ministry leadership.
Special Needs (dietary or physical)
I give permission for my child to be given Tylenol or other minor medication as needed.*

YesNo
Describe any behavioral or emotional problems that your child has that may affect their stay or participation in the event.
I understand that all reasonable safety precautions will be taken at all times by the 4th Episcopal District of African Methodist Episcopal Church staff. I have completed the information to the best of my knowledge. In giving my child permission to attend this event indicated, I release the 4th Episcopal District, the African Methodist Episcopal Church, leaders, and event staff from liability for damages, losses, illness, or injuries incurred by my child. I understand that I or the emergency contact listed on the registration form will be contacted. I hereby give permission to the physician or facility present to order X-rays, routine tests, and treatment for the health of my child.
Parent / Guardian Signature*

Clear
Photography Release

Please complete a Photography Release for every participant under 18.
I agree that THE 4TH DISTRICT may tape or photograph my child and record his

or her voice during their participation in the activity.

I agree that THE 4TH DISTRICT will be able to use them, in whole or in part,

whether in original or modified form, in any manner or media, including without

limitation, for advertising, promoting, and publicizing THE 4TH DISTRICT,

whether during the activity or thereafter.

I hereby release and discharge the Fourth Episcopal District of the African

Methodist Episcopal Church and all affiliated entities from all claims, demands,

or causes of action that I have in connection with the use and exercise of the rights

granted in this release.
Parent / Guardian Signature*

Clear

Pastor

$100.00

Adult Registration

Ages 27 & Up.

$115.00

Youth Registration

Ages 26 & Under.

$50.00

YPD Graduate Stole

$25.00

Enter coupon

Total

$0.00

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Christian Education Congress 2025 Registration

Adult Registration Form

Youth Registration

Participant Covenant

Emergency Medical and Release

Photography Release