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Church Organization
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Church Phone Number
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Pastor's Name
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Student Name
*
Student Age
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Please enter a number from
12
to
19
.
Gender
*
Male
Female
Parent/Guardian
*
Phone Number
*
Counselor
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If you don't have a counselor, please let us know in the box. We will provide a counselor for you. (The age range to be a counselor is 20+)
Phone Number (if applicable)
Emergency Contact
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Relationship to Student
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Emergency Contact Phone Number
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Please check one
Staying on Campus
Staying in a Hotel
Student must read and check the box below
*
I agree.
Morning services dressy casual.
Evening services dressy.
Modesty is required for activity time.
Parent or legal guardian must read and check the box below
*
I agree.
I agree to allow the directors of Lighthouse Forge Youth Conference to seek medical attention for my child in the event of an emergency or accident. I hereby waive my rights to hold Lighthouse Forge Youth Conference, Lighthouse Ministries, and/or its directors liable for any accidents during any activity associated with or connected to the Forge Youth Conference.
Phone
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