Summer Youth Conference Registration
August 19 - 23, 2013, in Hillsdale, NY

Each youth conference participant should fill out this form completely.
Please send the conference fee of $300 in a check made out to "The Christian Community.
Please put "Summer Y.C." in the memo line and send by August 9 to:

Summer Youth Conference
9221 Colesville Road
Silver Spring, MD  20910

Financial aid is limited but no one should stay away for lack of money.
Please Contact Rev. Patrick Kennedy if you would like assistance: 240-505-9960 or cckennedy2006@gmail.com
Once we receive your funds you will get an email with directions and further information.

Thanks!

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First Name *
Last Name *
Name of Parent(s) or Guardian *
Date of Birth *
Grade *
Gender *
Street Address *
City *
State *
Zip Code *
Home Phone *
Parent's Cellphone *
Participant's Email *
Parents' email(s) *
Do you need a ride to the conference?
Can you give someone a ride?
What are your eating habits and/or needs? *
please list any allergies or other needs/concerns in the "other" section
Please write "I understand" in the space below to show that you accept that any participant found to be behaving or supporting behavior that runs counter to the spirit of the conference will be asked to leave. *
If this happens, parents are then expected to arrange for the immediate pick-up of their child.
Other important notes, comments, info?
Please write us with any other important concerns, health issues, information about yourself/your child that you think would be helpful for our staff to know
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