Powerhouse Registration 2026
Please fill out the needed information to register for Powerhouse, 2026! It will be at Camp Mack in Milford, IN, Friday evening, Feb. 6 at 7pm-Sunday, Feb. 8 at noon. Dennis Beckner will be our guest speaker. Please fill one of these registration forms out for each youth/advisor separately. (So we can get an accurate count of people). Please bring a snack or drink to share and a game to share. 
Cost this year is $200 for advisors, and $200 for youth up until January 25. PLEASE REGISTER BY JANUARY 25! You can make checks payable to the Northern IN district Church of the Brethren, with "DYSCO-Powerhouse" on the subject line. When sending a check, please get it in by January 25. If you send a check, include a note about which person(s) it is for. The address of the Northern IN district office is: 301 Mack Drive Suite A Nappanee, IN, 46550. 
If you need any help with payment or have any questions (or if you have any youth that need help with payment), let Northern IN district youth advisors, Val Kline or Lucas Kauffman know. Val's cell phone number: 765-606-8541. Val's e-mail: v3kline@hotmail.com. Lucas' cell number: 574-312-0225. Lucas' email: lucaskauffman1210@gmail.com. 
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Name (Last, First)  *
Address (City, State, zip)  *
E-mail address *
Cell-phone number *
Grade Level *
Congregation/church you currently attend  *
District  *
Select your role *
Name two or three people who you would be fine sharing a room with.  *
Are there any dietary restrictions you have? (If none, put N/A).  *
Do you take any daily, current medications? *Medications will either be given to an advisor, or to one of the district youth leaders, to lock up, and hand out as needed.* *
Please provide the most up-to-date insurance information. (holder, policy number, group number) *
Do you agree to the following: to stay out of the rooms of the opposite gender, to stay out of buildings that are not being used by Powerhouse, to respect camp property, respect others, to not bring any alcohol, drugs, and tobacco, and to follow any other rules and regulations set forth by adult advisors.  *
I give permission for my child's picture to be taken for district purposes.  *
Emergency contact name:  *
Emergency contact cell phone number: *
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