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2021 Fall Youth Conference
Join us for CRC's Fall Youth Conference from Friday, November 19th at 5:30 pm to Saturday, November 20th at 4 pm. Students in 6th to 12th grades are welcome!
 
The conference will be held at Christ Community Church in Plainfield, NH: 1259 NH-12A, Plainfield, NH 03781.
Below you will find our online registration. When completed, click the submit button at the bottom of the page.
 
Below you will find our online registration. When completed, click the submit button at the bottom of the page.

Once you submit the form, you will be directed to complete your registration by filling out the Release Form via  an electronic signature service called 'Hello Sign'. If, for whatever reason, you are not prompted to go to Hello Sign, you can do so using the link provided in your confirmation email.

Questions? Contact Robert Moore at robert.moore@christredeemerchurch.org or 603-643-5588.
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Family Information
Family Name *
Mailing Address *
Email Address (of parent or guardian if a minor) *
If more than one parent should receive emails about this event, please include both emails (separated by a comma) here.
Parent/Guardian Name(s) *
Parent/Guardian Phone Number(s) *
In case of emergency, contact *
If you select a non-parental emergency contact, please include name and best phone number
Medical Information
Physician Name & Phone Number *
Dentist Name & Phone Number *
Medical Insurance Company *
Group #/ ID # *
Insurance Address & Phone *
First Participant Registration
First Participant's Name *
First Participant's Date of Birth *
First Participant Grade *
Date of last Tetanus Shot *
List any pre-existing medical conditions or any food or drug allergies that would be pertinent for this retreat:
List current medication/dosage:
Anything else we should be aware of?
Second Participant Registration
Second Particpant's Name
Second Participant's Date of Birth
Second Participant Grade
Date of last Tetanus Shot
List any pre-existing medical conditions or any food or drug allergies that would be pertinent for this retreat:
List current medication/dosage:
Anything else we should be aware of?
Third Participant Registration
Third Particpant's Name
Third Participant's Date of Birth
Third Participant Grade
Date of last Tetanus Shot
List any pre-existing medical conditions or any food or drug allergies that would be pertinent for this retreat:
List current medication/dosage:
Anything else we should be aware of?
Fourth Participant Registration
Fourth Particpant's Name
Fourth Participant's Date of Birth
Fourth Participant Grade
Date of last Tetanus Shot
List any pre-existing medical conditions or any food or drug allergies that would be pertinent for this retreat:
List current medication/dosage:
Anything else we should be aware of?
Additional Information
Name of Friend who invited you
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