Impact Lansing 2026 Registration 
Event Timing: July 12-18 2026
Contact us at impactlansing@gmail.com 
Email *
Student Name *
Grade EXITING this past school year (25/26) *
Required
Parent Email *
Parents names & phone numbers  *
Gender  *
Required
With what church youth group is your student attending?  *
Emergency Contact Name & Number (if parents cannot be reached)  *
T-Shirt Size (note these are adult sizes only)  *
Insurance Carrier & Policy Number  *
Allergies / Health Concerns we should be aware of *
Anything else we should know concerning your child?  *
PAYMENT & RELEASE - 
I give permission for my child's image to be used in any further promotional materials for Impact Lansing.  
 *
PAYMENT SUBMISSION METHOD -  *
I understand that payment in full is due by June 24th, 2026 and there will be no refunds granted after June 24th, 2026.   *
Required
FOR STUDENT TO READ & CHECK - I understand that while participating in Impact Lansing 2026, I will be representing God to the Greater Lansing Area.  I commit to serve in a positive way so that my actions, words and attitude will be a reflection of Christ's love to the Impact Lansing team, leaders and greater Lansing community.  I commit to following all the rules given and understand that my failure to abide by those rules MAY result in being asked to leave Impact Lansing.   *
Required
FOR PARENT/GUARDIAN TO READ & CHECK - I give permission for my child to participate in Impact Lansing 2026.  I release Impact Lansing, it's staff and representatives as well as the host church from any liability resulting from injuries, harm or death associated with this project and/or events associated with this trip, and give my permission and consider for such travel.  I give my consent for the director and/or leaders to seek medical treatment for my child if I am unable to be reached.   *
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms