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Gathering Registration Form - Lake Forest
Male / Female
Participant Type
T-Shirt Size
Last Name
Your answer
First Name
Your answer
Participant Age at Gathering
Participant Grade Level
Street Address
Your answer
City
Your answer
State
Zip Code
Your answer
Participant / Adult Leader Home Phone
(xxx) xxx-xxxx
Your answer
Participant / Adult Leader Cell Phone
(xxx) xxx-xxxx
Your answer
Participant / Adult Leader / Primary Adult Leader - Email Address
Required for Primary Adult Leader
Your answer
Congregation Name
Your answer
Congregation City/State
Your answer
Parent / Guardian Name
If you are an adult, enter 'Self'
Your answer
Parent / Guardian Cell/Work Phone
Your answer
Emergency Contact for Participant
Must be someone NOT attending the gathering
Your answer
Emergency Contact Phone (Home or Cell)
(xxx) xxx-xxxx
Your answer
Participant Agreement
I agree to participate and cooperate in every way at the 2015 Southern District Junior Youth Gathering. I am willing to take an active part in all events
Adult Leader Guidelines Agreement
I have read the adult leader guidelines and agree to abide by them (see Southern District web site for guidelines). I will lead my group in full participation of all Gathering activities and am willing to assist where I can. I hereby agree to serve as a Family Group Leader for the 2015 Southern District Junior Youth Gathering.
Photo Use Authorization
I authorize the Southern District to have and use reasonable photographs, slides, moving pictures and audio/video tapes of myself for purposes of legitimate Southern District records, public relations and/or advertising.
Special Physical Needs (Confidentiality Maintained)
Please list any dietary restrictions, medications, allergies, diabetes, conditions, or other illnesses. (Please list any pertinent information).
Your answer
If you are the primary adult leader, please check this box to signify that your congregation has completed registration and a recap of your registration information will be emailed to you at the email address provided.
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