Philly Intensive 2024
Hope Community Church | Gilbertsville, PA
Sign in to Google to save your progress. Learn more
Email *
STUDENT INFO
Please fill out a separate registration for each student attending. Thank you!
Student Last Name *
Student First Name *
Student Home Address *
Student Email Address *
Current Grade (2023/2024 school year) *
Allergies *
List any of your student's allergies
Student T-shirt Size
All shirt sizing is adult sizing.
 *
PARENT/GUARDIAN INFO
Parent/Guardian Full Name *
Parent/Guardian Relationship to Student *
Parent/Guardian Email Address *
Parent/Guardian Phone Number *
2nd PARENT/GUARDIAN INFO (optional)
2nd Parent/Guardian Full Name (optional)
2nd Parent/Guardian Relationship to Student (optional)
2nd Parent/Guardian Email Address (optional)
2nd Parent/Guardian Phone Number (optional)
PHILLY INTENSIVE REGISTRATION
The cost for Philly Intensive, including food and travel, is $165. Check the box to certify that you have read and agree to the payment dates & values below. *
The $80 deposit is due April 7th and the total balance is due June 23rd.  NOTE: Please make all checks payable to Hope Community Church.
Captionless Image
Required
Student Trust Fund Account *
When students participate in fundraisers, they earn money that is placed in their student trust fund account.  
Required
All paperwork is due April 7.  Forms can either be emailed back to Sarah@hopegilbertsville.org, placed in the Youth Box located inside the Hub (pictured below), or they can be mailed directly to HCC (2732 N. Charlotte St. Gilbertsville, PA 19525).
Would you like to discuss a scholarship option for your student to help toward the total cost of Weekend Intensive with Pastor Kyle? If you are requesting a scholarship, we ask these students to contribute an amount of some kind, to participate in fundraising, and regularly attend Hope Student Ministries. *
Additional Forms / Background Checks *
If your student is 18 years of age and older, our church Admin, Sharon Gery, will be contacting you regarding your HCC Volunteer Forms & PA Clearances.  In an effort to stay compliant with PA state regulations, these forms will need to be completed by all adult volunteers 18 years of age and older.
Required
Minor Release Form *
A current 2023-24 HSM Minor Release Form is mandatory for this trip. If you have not yet filled one out for your student, please do so and hand one in. You can click the link below to download the form or find it on the church website.   
Insurance Card *
A copy of the front & back of your Insurance Card needs to be handed in along with your Minor Release Form.
REGISTRATION AGREEMENT
By completing & submitting this form you are agreeing to pay for the entire cost ($165) of the Philly Intensive 2023 trip. The $80 deposit is due April 7th and the final balance is due June 23rd. After June 25th, we will NOT be able to refund any payments. If your student cannot attend, please inform Pastor Kyle in writing by June 25th. 
I, the parent/guardian of the student listed agree to the statement above. (type name below) *
Today's Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms