2026 Middle School Youth Gathering Participant Registration

Middle School Youth Gathering Participant Registration

This form is required to register your child/self for the Nebraska District LCMS Middle School Youth Gathering. One form per participant. **You will need the name and email address of your congregation's Primary Adult Leader to complete this form.**
This form is for:

Middle School Youth Gathering Congregation Contact

Your primary adult leader should have provided an email address to use when registering for the gathering. Please add THEIR email address below, NOT your own.
Primary Adult Leader Name (primary congregation contact person)
Primary Adult Leader Email Address (primary congregation contact)
example@example.com
Congregation Name
Middle School Youth Gathering Participant Information
Gathering Participant Name

First NameMiddle NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your email address
For adult leaders
Cell phone number
Please enter a valid phone number.Format: (000) 000-0000.
Gender
Participant's date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Participant age at time of Gathering
Grade
Parent/Guardian Name(s)
Primary phone number of parent/guardian
Please enter a valid phone number.Format: (000) 000-0000.
Secondary phone number for parent
Please enter a valid phone number.Format: (000) 000-0000.
Please list any food allergies or dietary restrictions
Participant shirt size
Authorization & Consent

Required for all participants
I have completed a Medical Consent Form for my child and submitted it to the group's Primary Adult Leader.
I/We, give permission for my/our child to attend and fully participate in the Nebraska District Middle School Youth Gathering.
I/We understand that there will be photos and videos taken throughout the weekend to be used during the Gathering. The recap video is the only piece that will be posted publicly, to be used for promotion for future events. It will be your Primary Adult Leader's responsibility to manage those participants who should not be included in the recap video.
I certify that I am at least 21 years old
I have completed a Medical Consent Form and submitted it to the group's Primary Adult Leader.
I hereby agree to serve as an adult leader and to participate fully in the Nebraska District Middle School Youth Gathering. I will supervise and care for all members of my congregation throughout the Gathering experience.
I understand that there will be photos and videos taken throughout the weekend to be used during the Gathering. The recap video is the only piece that will be posted publicly, to be used for promotion for future events. It will be your Primary Adult Leader's responsibility to manage those participants who should not be included in the recap video.
Please type your full name below in lieu of your signature. By typing your full name in the box below, you agree that the information provided is correct to the best of your knowledge.
Should be Empty:

Middle School Youth Gathering Participant Registration

Middle School Youth Gathering Congregation Contact

Middle School Youth Gathering Participant Information

Authorization & Consent