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Teen Encounter Christ Application
Welcome to Bloomington/Normal TEC online Registration.

The TEC APPLICATION is made up of three separate intake forms: The candidates input form; parental permission form; and a PERSONAL ADULT RECOMMENDATION form. All parts can be completed on-line.

This is PART ONE ONLY!

( USE THE TAB KEY or MOUSE TO NAVIGATE.)

Email address *
The TEC you plan to attend? *
For a list of current TEC weekends, click here. http://bn-tec.org/sign-up
YOUR FIRST NAME *
Your answer
YOUR LAST NAME *
Your answer
YOUR DATE OF BIRTH .. (MM / DD/ YYYY) *
TEC is designed for persons age 16 to 20.
MM
/
DD
/
YYYY
What will be your age at the TEC weekend? *
Example: 18
Your answer
Your Gender *
YOUR MAILING ADDRESS *
(Number) , (Street) , (Apartment or Unit)
Your answer
CITY *
Your answer
STATE *
PLEASE use TWO LETTER Abbreviation (ie. IL for Illinois)
Your answer
ZIPCODE *
Your answer
SCHOOL *
If not currently enrolled, enter "N/A"
Your answer
PARISH / CHURCH AFFILIATION *
If you do not currently belong to a specific Church congregation, enter "N/A"
Your answer
How did you hear about TEC? *
Please list your primary interest, hobbies, or school activities
Sports, Drama, Music, Student Council, etc.
Your answer
What do you hope to get out of your TEC experience?
Your answer
Are you a vegetarian or do you have dietary restrictions? *
If you have dietary restrictions, please elaborate!
Your answer
Candidate Email Address *
NOTE: EMAIL is our "official" means of communication and the primary way we will communicate with you. Please provide an email address that you check regularly. PLEASE DO NOT provide Facebook, Twitter or other social network accounts.
Your answer
PHONE NUMBER ( + Area code) *
Where YOU can be contacted with questions about your application, if necessary.
Your answer
FATHERS NAME (or name of SINGLE PARENT/GUARDIAN) *
( First ) ( Last )
Your answer
MOTHERS NAME (If you named a single parent/guardian above, this field may be left blank)
( First ) ( Last )
Your answer
YOUR PARENTS ACTIVE EMAIL ADDRESS *
In the event your parents don't have email, enter bloomingtontec@bntec.org.
Your answer
Do you live with your parents/guardian?
Emergency Contact Person *
(In the event of an medical emergency, ex. parents or grandparents)
Your answer
Emergency Contact Phone Number *
Provide phone number of your emergency contact listed above.
Your answer
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