Revolution Youth Conference Event Registration
Event: March 15 - 16
Cost: $35
Event Address: 1315 W. Bristol Road Flint MI 48439
Contact us at 731-614-7000 mooremusic2002@gmail.com
Email address *
Please list all Students first and last names and grades that are registering for the event. (ex - Joe - 7th) *
Your answer
Student Cell Phone (Day of the Event) If None type None *
Your answer
Home Address *
Your answer
Schools (ex - Joe Grand Blanc West, Laura - Fenton) *
Your answer
Grade *
Required
Adult t-shirt size and quantity Small - 3 XL (ex - Laura - Small, Joe - Medium *
Your answer
Church or Youth Group *
Your answer
Parents Name *
Your answer
Emergency Contact Name & Relation *
Your answer
Emergency Contact Phone Number *
Your answer
Please list any Adult/Adults (18+) authorized to pick up student *
Your answer
All Allergies (Food & Medicine) *
Your answer
I allow RYC to use any pictures of my students on publications and social media post *
Social Media (check all that apply) *
Required
Are You Interested in info about the Bristol Road Church or Youth Group? *
Payment instructions will be emailed to you once this form is completed along with a link to online payment.
A copy of your responses will be emailed to the address you provided.
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