Central Iowa Teens Encounter Christ

Central Iowa Teens Encounter Christ

Youth Candidate Application
TEC #80

March 3-5, 2023

Location:

Trinity Reformed Church

407 Frankin St

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!
First Name*
Last 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 Code Phone Number
School*
Birth date*
Class of*
Shirt Size*

SmallMediumLargeExtra LargeExtra Extra Large
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 is know if you do not.
Parent Home Phone*

Area Code Phone Number
Primary Cell Phone*

Area Code Phone Number
Secondary Cell Phone

Area Code Phone Number
Secondary Cell Owner

First Name Last Name
I, recognize that churches and dominations 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 on used on for TEC social media purposes

YesNo
Payment Information

$50 Payment is due at or before the TEC weekend.
My Products
prevnext( X )
Send a Check $50 (No Processing Fee) to Wendy Sims @ 384 223rd Place Pella IA 50219 (separate from parent letter) $ Free

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

My Church or youth group pays for my registration (This MUST be confirmed with church) $ Free

Give payment to an adult at TEC drop off $ Free

Venmo @CITEC $ Free

Total $0.00
Type a question
Parents Electronic Signature. *
Date

MonthDay Year
Date

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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