D3 Youth Conference 2026

--REGISTRATION--

D3 - High School Youth Conference
June 21-26, 2026
- Registration Deadline: March 11, 2026
- $50/person deposit due with registration
- Total Cost: $450/person. Students have the option to raise support through letters. The balance of $400 is due by April 22, 2026. You will receive reminder emails with payment options.
- Refund policy:
  Full refund (excluding $50 deposit) if cancelled by April 30, 2026.
  50% refund (excluding $50 deposit) if cancelled May 1-8, 2026.
  No refund after May 8, 2026, 11:59pm.
This form must be filled out by the student's parent or legal guardian.
Number of Students You are Registering*
Student #1
Name - Student #1*

First NameLast Name
Address - Student #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth - Student #1

MonthDayYear
Date
Grade - Student #1*
T-Shirt Size - Student #1*
E-mail - Student #1
Cell Phone - Student #1
Format: (000) 000-0000.
Cost for Student #1
Student #2
Name - Student #2*

First NameLast Name
Address - Student #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth - Student #2

MonthDayYear
Date
Grade - Student #2*
T-Shirt Size - Student #2*
E-mail - Student #2
Cell Phone - Student #2
Format: (000) 000-0000.
Cost for Student #2
Student #3
Name - Student #3*

First NameLast Name
Address - Student #3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth - Student #3

MonthDayYear
Date
Grade - Student #3*
T-Shirt Size - Student #3*
E-mail - Student #3
Cell Phone - Student #3
Format: (000) 000-0000.
Cost for Student #3
Student #4
Name - Student #4*

First NameLast Name
Address - Student #4

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth - Student #4

MonthDayYear
Date
Grade - Student #4*
T-Shirt Size - Student #4*
E-mail - Student #4
Cell Phone - Student #4
Format: (000) 000-0000.
Cost for Student #4
Any Allergies or Dietary Restrictions we should be aware of?*
Parent/Guardian Information:
Name - Parent/Guardian #1*

First NameLast Name
Email - Parent/Guardian #1*
example@example.com
Phone Number - Parent/Guardian #1*
Format: (000) 000-0000.
Name - Parent/Guardian #2

First NameLast Name
Email - Parent/Guardian #2
example@example.com
Phone Number - Parent/Guardian #2
Format: (000) 000-0000.
Emergency Information:
Medical Insurance Company*
Policy Number*
Physician's Name*
Physician's Phone Number*
Format: (000) 000-0000.
Parental Agreements:
PHOTO RELEASE: I understand and will allow photos and videos of my child to be taken while attending Ebenezer Bible Fellowship Church events or activities and to be used in any Ebenezer Bible Fellowship Church publication.*

YesNo
Notes & Payment Information:
Any questions/comments for Pastor Josh?
Total Cost $
$450/person
Deposit Due Now $
$50/person
Payment Option*

Pay Deposit: Online NowPay Deposit: by Bringing/Sending a Check
Check Payment Amount $
Online Payment Amount Field for Programming
Pay Online Now

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USDD3 Youth Conference
Check Instructions:
- Checks should be made payable to Ebenezer BFC, Memo: D3.
- Please put in the office drop box, or mail to the church: 3100 Hecktown Rd. Bethlehem PA 18020.
- Checks must be mailed the day this form is submitted, or dropped off at the church within a week.
Should be Empty: