Youth* Helper

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Adult Chaperone / Adult Helper / Youth* Helper Registration 2018

Adult Chaperone / Adult Helper / Youth* Helper Registration 2018

Friday May 4, 2016 @6pm – 9:30pm

Friday May 4, 2016 @6pm – 9:30pm

Please return this completed form along with your REGISTRATION FEE to your church leader.

Please return this completed form along with your REGISTRATION FEE to your church leader.

REGISTRATION FEE $30/Adult Chaperone

REGISTRATION FEE $30/Adult Chaperone

Price includes t-shirt, SWAG bags, snacks, and more!

Please make checks payable to JACOB’S WELL. Please write your name on memo line. Please return money and completed form to your church leader(s). NOTE: registration must be in by Apr. 18, 2018 if you would like a t-shirt (FREE) and/or sweatshirt ($25)

Payment Method Cash

Check

Price includes t-shirt, SWAG bags, snacks, and more!

Please make checks payable to JACOB’S WELL. Please write your name on memo line. Please return money and completed form to your church leader(s). NOTE: registration must be in by Apr. 18, 2018 if you would like a t-shirt (FREE) and/or sweatshirt ($25)

Payment Method Cash

Check

PERSONAL INFORMATION

PERSONAL INFORMATION

Full Name:

Full Name:

Address:

Address:

City/State/ZIP:

City/State/ZIP:

Phone:

Phone:

Email:

Email:

Birthdate:

/

/

Gender:

M

T-Shirt* (Adult SizesOnly | Included in Registration Fee): S

M

Sweatshirt (Adult Sizes Only | Add $25): S

XL

M

L

F L

Birthdate: XL

XXL

XXL

*NOTE: registration must be in by Apr. 18, 2018 if you would like a t-shirt (FREE) and/or sweatshirt ($25)

RELEASE

I understand that attendance to this event grants permission for me to be filmed, photographed, audio taped, etc and grants FUEL permission for full use of my likeness and words without compensation.

/

/

Gender:

M

T-Shirt* (Adult SizesOnly | Included in Registration Fee): S

M

Sweatshirt (Adult Sizes Only | Add $25): S

XL

M

L

F L

XL

XXL

XXL

*NOTE: registration must be in by Apr. 18, 2018 if you would like a t-shirt (FREE) and/or sweatshirt ($25)

RELEASE

I understand that attendance to this event grants permission for me to be filmed, photographed, audio taped, etc and grants FUEL permission for full use of my likeness and words without compensation.

YOUR SIGNATURE

YOUR SIGNATURE

*YOUTH is defined as any helper you bring with your group who is between 9th grade and 12th grade

*YOUTH is defined as any helper you bring with your group who is between 9th grade and 12th grade