SPARK Group Registration Form
Please fill out your group details to register for SPARK MidSouth GMC Youth Retreat. Youth groups are responsiblity for MinistrySafe or other background checks for volunteers and resposible for youth group members. If you have any questions please text or call Charlie Shoemaker (859) 230-8359
Church Name
*
Group Leader / Primary Contact Name
*
First Name
Last Name
Primary Contact Email Address
*
example@example.com
Primary Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Group Leader / Alternate Contact Name
First Name
Last Name
Group Leader / Alternate Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name for Group
*
First Name
Last Name
Emergency Contact Phone Number for Group
*
Please enter a valid phone number.
Format: (000) 000-0000.
How many people will attend?
*
Any group-wide special notes
Pastor Name
*
First Name
Last Name
Pastor Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Pastor Email Address
*
example@example.com
Register Group
Should be Empty: