SBC Youth God Encounter Registration Form
- High School Students ONLY!
- Located at Second Baptist Church
- All communication email youthgodencounter@gmail.com, the Facebook Group - Youth God Encounter, or call 305-232-0499 ext 130
- Information Packet will be sent after receiving this registration form
Student Name (First & Last Name) *
Your answer
Student Name as you want it to appear on your name tag (Official Nicknames Only)
Your answer
Student Grade *
Student Date-of-Birth *
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DD
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YYYY
Student Gender *
Church/Youth Group Affiliation
Your answer
Student Cell Phone *
Your answer
Student Email *
Your answer
Student Facebook Name/Email using for the conference
Your answer
Parent Name *
Your answer
Parent Address *
Your answer
Parent Email
Your answer
Parent Contact # *
Your answer
Emergency Contacts (Name, Relationship, Contact #)
Your answer
Does your child have any allergies, food restrictions, physical and/or behavior concerns we should be aware of? Please note the youth staff will not be administering any medications, this is solely the responsibility of the parent.
Your answer
Informed Consent: I understand that I will be notified if my child listed on this form becomes injured and/or ill while attending Youth God Encounter Workshops and/or Shut-in *
Informed Consent: I agree that upon notification of my child’s injury and/or illness, I will have him/her picked up immediately. *
Informed Consent & Authorization for Emergency Treatment: In case of an emergency or when I cannot be reached, I hereby give authorization to the Youth Shut-In staff to contact other emergency contact people listed on this form. If no one listed on this form can be reached, then I hereby give authorization to the Youth Shut-In staff and the treating physician to obtain or provide whatever medical treatment and/or transportation deemed necessary for the immediate welfare of my child listed above. *
Condition of Enrollment: I have read, understand, and agree to the terms and conditions listed on this Emergency Contact Form and I understand it is my responsibility to provide accident and health insurance coverage for my child and I will be financially responsible for all charges and fees for emergency medical treatment and/or transportation, regardless of whether my medical insurance covers such charges and fees. *
Topic & Event Consent: By typing my name below as the parent/guardian and submitting this electronic form, I have read, understand, and agree to my child participating in this event and to participate in the below topic discussions: 1. The JUMP: Tools of Spiritual Warfare & Isaiah 58 Fast (Coed Classes). 2. Identity Crisis - Knowing who you are as an individual & who you are in Christ (Separate Female & Male Classes). 3. Self Esteem/Self-Image, Values, Standards, Boundaries, Abuse & Addictions (Separate Female & Male Classes). 4. Relationships, Sexuality & Love (Separate Female & Male Classes). 5. Overcoming Challenges & Disappointments, Loss & Grief, Discipleship & Righteousness, The Wait (Separate Female & Male Classes). 6. The Real Talk Show: The 'Real Court' - Don't Judge Me but Let's Get Real. The 'Real Hot Seat' - Set the Record Straight about The Road to Destiny, Responsibilities, Commonality vs Spirituality, Life Outside the Four Walls & Being Away From Home. The ‘Real Facts’ vs Fiction & Baggage Check (Coed Classes). 7. Men & Women Etiquette: Interacting with the Opposite Sex (Coed Classes). 8. What's Next After the Youth God Encounter (Co-ed Breakfast). Write your name in the short answer text if you approve. *
Your answer
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