Individual Registration Form

Please fill out this form and click submit.

Registrant Section

Name

Address

Date of Birth

Gender

Please select one option.

Male Female

This address will receive a confirmation email

Phone

T-Shirt Size:

Please select one option.

Small Medium Large XLarge 2XLarge 3XLarge

I intend to receive the Lord's Supper at the Divine Service.

Please select all that apply.

Yes No

I have attended a Higher Things conference before.

Please select all that apply.

Yes No

Indicate which age group the Registrant will be at the time of the conference.

Please select all that apply.

Infant (0-1) Toddler (2-4) Child (5-11) Youth (12-17) Young Adult (18-20) Adult (21+) Pastor

I have a disibality/medical conditions/dietary or special need:

Please select all that apply.

Yes No

Please only include special needs that affect housing assignments and/or dietary requirements. Other special needs should be discussed with your Group Leader and chaperones.

Group Church Name

Church Phone

Church Address

Group Leader's Name

Pastor's Name

Parent/Guardian Section (required for minor youth participants only)

Name

Phone

Address (if different from above)

Parent's Email

This address will receive a confirmation email

I grant permission for my minor child, named above on this form as "Registrant," to attend the Higher Things youth conference. I assume all responsibility and liability for injury to said minor while at the Higher Things conference. I also give Higher Things, Inc. permission to use any still, audio, and/or video images of my child in conference publicity and news releases. (Parent's Signature and Date)

Description

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Individual Registration Form

Description

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