EYC Registration Form

Student Information

Student name*

First Last

Name I preferred to be called by*

Gender*

My grade during the 2018-19 school year*

9th grade
10th grade
11th grade
12th grade

Expected year of high school graduation*

Date of birth*

Student email*

Enter Email Confirm E-mail

Student phone*

Type of phone*

What size t-shirt do you wear?*

Tell us about you

My favorite subjects in school*

Math
English
Science
Physical education
History
Social Studies
Spanish, French, or other language
Art
Other

Other

My favorites things to do in the summertime*

Other

Please tell us something about yourself that you would like us to know:*

Why do you want to participate in EYC this summer?*

References

Please provide the name of a pastor or youth group leader who can recommend you for this program.*

First Last

Email of pastor or youth group leader*

Enter E-mail Confirm E-mail

Phone of pastor or youth group leader*

Type of phone*

Parent/Guardian Information

Parent/Guardian name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian primary phone*

Type of phone*

Parent/Guardian alternate phone*

Type of phone*

Parent/Guardian email*

Enter E-mail Confirm E-mail

Do you plan to attend EYC as an advisor?*

Yes
No

While attending EYC, will your child be under the age of thirteen?*

Child Online Privacy Protection Act*

By checking this box, I give permission for my child to provide the personal information required to register for EYC. I understand that I may contact Bethany Theological Seminary at any time to review the information that Bethany has on my child. I know that I may request for the information to be deleted after the conclusion of the event.
I do not give permission for Bethany Theological Seminary to collect my child's information over the internet.

Congregation*

District*

Registration Fee

Registration fee*

$25 registration fee

By checking this box, you are acknowledging the $25 registration fee is required to attend EYC. Please mail checks to: EYC Registration, Bethany Theological Seminary, 615 National Road West, Richmond, IN 47374-4019

You will receive the details of the Child Online Privacy Protection Act and our office's contact information in an email after you click the submit button.

Join us for Explore Your Call July 19-29, 2019, on the campus of Bethany Theological Seminary

Student Information

Tell us about you

References

Parent/Guardian Information

Registration Fee

Join us for Explore Your Call
July 19-29, 2019, on the campus of Bethany Theological Seminary