Empowerment Sessions Registration

The Making of a Pearl

"I am valuable before I am polished."
Empowerment Sessions Registration

Registration form for New Bethel R.E Church Youth Department Empowerment Sessions. Complete the youth, parent/guardian, interests, concerns, acknowledgment, permission, and signature fields as provided.
Youth Name

First NameLast Name
Youth Age
Youth Grade (2026–2027 School Year)
Youth Gender
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Relationship to Child
Parent/Guardian Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Session Interests and Current Challenges
Session Interests

Other
Session Interests - Other Topic
Current Challenges

Other
Current Challenges - Other
Parent Concerns and Goals
What concerns do you currently have regarding your child that you would like our Empowerment Sessions to address?
What are your child's greatest strengths?
Additional concerns, goals, or specific topics for speakers or youth leaders
One thing you hope your child gains from these sessions
Commitments, Permissions, and Signatures
Attendance Commitment Acknowledgment
Parent/Guardian Signature (Attendance Commitment)
Date (Attendance Commitment)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Photo/Media Permission
Interested in volunteering during youth events
Would you like follow-up resources for parents?
Parent/Guardian Please Be Advised:

Please note that while we strive to address all questions and concerns during group sessions, we may not be able to respond to all individual requests or specific issues in the group setting. If you have particular concerns or topics that are not covered during the sessions, we welcome you to discuss these with us on an individual basis. Please reach out to schedule a one-on-one conversation so we can better address your specific needs.
Parent/Guardian Signature (Final)
Date (Final Signature)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

The Making of a Pearl

Empowerment Sessions Registration

Parent/Guardian Information

Session Interests and Current Challenges

Parent Concerns and Goals

Commitments, Permissions, and Signatures