Powerhouse Registration 2025
Please fill out the needed information to register for Powerhouse, 2024! It will be at Camp Mack in Milford, IN, Friday evening, Feb. 7 at 7pm-Sunday, Feb. 9 at noon.  Please fill one of these registration forms out for each youth/advisor separately. (So we can get an accurate count of people). 
Cost this year is $160 for advisors, and $160 for youth up until January 15. After January 15, the price will go up by $10 each. 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 24. 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 not bring any alcohol, drugs, and tobacco, and to follow any other rules and regulations set forth by adult advisors.  *
Emergency contact name:  *
Emergency contact cell phone number: *
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