Central Iowa Teens Encounter Christ

Central Iowa Teens Encounter Christ

Youth Candidate Application
TEC #86

March 7-9, 2025

Location:

First Church

605 Broadway

Pella, IA 50219

Candidates are expected to be present for the entire weekend (from Friday at 10 a.m.-6:00 p.m. on Sunday). This may include an absence from school.

Applications are accepted for candidates beginning the summer before their sophmore year of high school though the summer after their senior year.

Primary contact will be made to the parent email and students will also receive a seperate email. Please let us know ASAP if either of you DO NOT receive this email!
Last Name*
First Name*
Name to be called if different from above.
Gender*

MaleFemale
Address*
City*
State*
Zip*
Email*
You should get a follow up e-mail. Send us an email if you do not!
Student Cell Phone*

Area CodePhone Number
School*
Birth date*
Class of*
Shirt Size*

SmallMediumLargeExtra Large2 XL3 XL
Who told you about TEC? (Name names!)
If applicable:
Church
Youth group you attend
City
Parent or Legal Guardian Information
Parent/Legal Guardian*
Parents Email *
You should get a follow up email. Let us know if you do not.
Parent Home Phone*

Area CodePhone Number
Primary Cell Phone*

Area CodePhone Number
Secondary Cell Phone

Area CodePhone Number
Secondary Cell Owner

First NameLast Name
I, recognize that churches and denominations have varied views on who may take communion. I understand that communion will be served during the TEC weekend and give permission to my son/daughter to make the decision whether or not to participate.*

YesNO
Health Information

In the event of a medical EMERGENCY, I hereby grant permission to the physician selected by the TEC leadership to secure proper treatment for my child as named above. I certify that there is no guarantee or assurance has been made as to the result that may be obtained.
Medical Insurance Company*
Policy Number*
Medical/Allergy/ Dietary/Special Needs*
Photo Release
I agree that photos of my child can be taken and used on TEC's social media platforms

YesNo
Parents Electronic Signature. *
Date

MonthDayYear
Date
Please check the Student and Parent email for important information for you both. Let us know if you DO NOT receive it!

We are excited to meet your student!!

Please join us in prayer for the weekend!!
Payment Information

$50 Payment is due before the TEC weekend. Refunds will be issued up to 14 days before the event. (One of these options must be selected to for the registration process to be completed and your spot reserved)
Payment
prevnext( X )
Send a Check $50 (No Processing Fee) to Wendy Sims @ 384 223rd Place Pella IA 50219 (separate from parent letter) Checks payable to CITEC. Spots will NOT be held until payment is received. $ Free

PayPal (or Credit Card) Registration + Processing and Registration Fee$50.00

My Church or youth group pays for my registration $ Free
(Pick one from drop down)

Name of Church or Youth group that pays for your registration

Venmo @CITEC$ Free

Scholarship$ Free

Other$ Free

Total $0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Central Iowa Teens Encounter Christ

Parent or Legal Guardian Information

Health Information

Photo Release

Payment Information