Surge Encounter 2019 Leader Registration
Name of Event: Surge Encounter 2019
Dates of Event: Wednesday-Saturday, June 19-22, 2019
Location: Colorado Christian University
8787 W Alameda Ave, Lakewood, CO 80226
Website: www.ccu.edu (please refer to website for more information)

Leaders must have completed high school by the date of Surge Encounter and be at least 18 years old to be eligible to register and attend as a leader.

Cost: $240 (Includes lodging, meals, activities, and t-shirt)
$75 deposit due by Sunday, March 25th. Additional $75 payment due by Sunday, April 22nd. Final balance due by Sunday, May 20th.

Email address *
Leader Name *
Your answer
Gender *
Age
Your answer
T-shirt Size (Adult sizes) *
Home Church
Your answer
Preferred Roommate
Your answer
Address, City, Zip *
Your answer
Select which job titles you feel you would be best at or desire to do. *
Required
List other job title that is not listed above that you feel you would best be used in.
Your answer
List any physical limitations we should know about. (If none, type "None".) *
Your answer
Do you have an up-to-date background check on file with your church? (If no or unsure, please verify with your church.) *
Have you ever been convicted of physical or sexual abuse?
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
CHAPERONE GUIDELINES
Listed below are some specified basic guidelines for NCC Chaperones. This is expected of every adult person attending any NCC sponsored activities as a Youth Leader Chaperone. This, again, is only a basic outline. Please remember that anywhere and everywhere we go, we represent Jesus Christ, the Head of the Church. We also represent our Pastors and the NCC Family. Common sense is always a good guide, but the following guidelines are in place to make sure that we are all in accordance with one another.

As a Burn Leader it is my responsibility to:

 Report any behavior that even raises the question of, “Should I let someone know?” This behavior must be communicated immediately to those in leadership positions (i.e. Youth Ministers).
 Make sure the young people show respect to all adults in authority at all times, whether they know them or not.
 Handle any and all loud noises and/or distractions on the bus, especially while driving, so the driver can hear properly.
 Make sure the young people stay seated while on the bus, especially while it is moving.
 Check for and to discard all trash as well as any messes left on the vans, or any other place in which our young people are guests.
 Have my cell phone with me, charged up and on during the entire trip. Communication between chaperones will be done via cell phones. The Youth Ministers will designate which cell phones will be used in case of any emergency.
 Attend to matters initiated by a young person immediately.
 Not allow young people to run or make loud noises in the restaurants or any other buildings that we are guests. They may not wrestle or move furniture in the places we are guests without permission.
 Stay with my assigned youth(s) at all times.
 Make sure all young people eat at all designated meal times and do not skip without permission. If there is a problem, I will report it immediately.
 Abide by the standards set by Burn Youth Ministers, i.e. males with males and females with females.
 Make sure the young people carry around their own belongings to and from the vans.
 Realize that I am called and anointed by God and relied on by our Pastors to make sure our young people enjoy a powerful, Godly experience in the safest environment possible.
 Make note of any and ALL incidents that happen so they can be recorded on our Incident Report Cards at the conclusion of the event. I must be sure to record all the facts and no innuendo. When in doubt, I will fill it out.

I have read and do understand and agree to all of the above

Chaperone Name *
Your answer
Date *
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Payment Information
Cash or check only. Please make checks payable to New Creation Church. Drop off or mail checks to New Creation Church, 737 Bross St., Longmont, CO 80501

Cost: $240 (Includes lodging, meals, activities, and t-shirt)
$75 deposit due by Sunday, March 24th. Additional $75 payment due by Sunday, April 21st. Final balance due by Sunday, May 19th.

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