Breakthrough Weekend Registration
How did you PAY - Cost $80 *
Required
Age (Must be 18 years old or Over) *
Your answer
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Gender *
Cell Phone *
Your answer
Home Phone
Your answer
Which Campus do you attend? *
Invited By: *
Your answer
Emergency Contact Person 1 (relatives/friends who will not be attending the Breakthrough Weekend): First and Last Name *
Your answer
Phone *
Your answer
Relationship *
Your answer
Emergency Contact Person 2 (relatives/friends who will not be attending the Breakthrough Weekend): First and Last Name *
Your answer
Phone *
Your answer
Relationship *
Your answer
Do you attend church? *
If so, which church?
Your answer
Do you attend a Microchurch? *
If so, Leader's Name?
Your answer
Status *
Any Allergies? If Yes, Please explain. *
Your answer
By typing name below, I hereby release Greenhouse Church, and the employees and volunteers of all above as well as ministries under the covering of those above, from any and all liabilities pertaining to the above named individual's involvement at Breakthrough. I also give consent for the staff and leadership to take the above named to any medical facility in the event that it is deemed medical treatment is needed. I give my consent for any nurse, physician, or medical technician to administer treatment to the above named in the event that it is deemed necessary. I realize that the emergency contact above will be notified immediately if such circumstance arises. I have listed all allergies and medications currently taking accurately above. TYPE NAME *
Your answer
If MARRIED and your SPOUSE is also ATTENDING the WEEKEND, submit this form for yourself and THEN CLICK "Submit another response" for your spouse.
Married attending together - Use the Same Confirmation Number if paid for both
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