Surge Encounter 2019 Church Registration
Email address *
Church Name *
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Youth Pastor *
Your answer
Pastor *
Your answer
Address, City, State, Zip *
Your answer
Contact Phone # *
Your answer
Expected # of students attending *
Your answer
Expected # of leaders attending (we need at least 1 male and 1 female leader and a ratio of 1 leader to 6 students) *
Your answer
Payment Information
Payment Deadlines:
1.) February 10th - Church Group $75 deposit (nonrefundable) to secure a spot for your group along with a numbers estimation. Note: This is a separate cost from the overall camp costs.
2.) Sunday, March 24th – Registration and first deposit of $75 (nonrefundable) per student and leaders due.
3.) Sunday, April 21st - Second deposit of $75 per student and leaders due.
4.) Sunday, May 19th - Final payment of $90 per student and leaders due.

We accept cash or check. Please make checks payable to New Creation Church. Drop off or mail payment to New Creation Church, 737 Bross St., Longmont, CO 80501.

A copy of your responses will be emailed to the address you provided.
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