2022 Mid-Atlantic Spring YP Conference Registration

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Deadline: Lord's Day, April 3, 2022

Email *

Last Name *

First Name *

Locality *

Beltsville

Dunn Loring

Fairfax

Gaithersburg

Richmond

Virginia Beach

Other:

Gender *

Brother

Sister

Grade *

College Student

Serving One

Other:

Do you need Hospitality? *

Yes

Rules *

The Rules and Regulations can be found at https://docs.google.com/document/d/1eZG7zGazwcdC1yJXbZ_FE5IF7KJ_egP76Ca_EGuaD1c/edit?usp=sharing

I have read the rules and regulations and agree to abide by them.

Required

Comments

Medical Release (Required for those under 18 - please have your parent fill this out) *

I authorize the bearers of this form to obtain any and all medical and/or emergency care which in the bearer's opinion is needed by my child and also accept full responsibility for the payment of any expenses incurred from such medical and/or emergency care.

Yes

Over 18 - Not required

Other:

Parent Name and Phone Number *

Alternate Contact Name and Phone Number *

Current medication, allergies, or health problems *

A copy of your responses will be emailed to the address you provided.

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