Immerse! Registration Form Immerse! Registration for Immerse! June 21st - 26th, 2018 on the campus of Bethany Theological Seminary in Richmond, Indiana. Student InformationStudent name* First Last Name I preferred to be called by*Gender*My grade during the 2017-18 school year*6th grade7th grade8th gradeDate of birth* Student email* Enter Email Confirm E-mail Student phone*Type of phone*Cell PhoneLand line/Home PhoneWork PhoneWhat size t-shirt do you wear?*Extra SmallSmallMediumLargeExtra LargeTell Us About YouMy favorite subjects in school* Math English Science Physical education History Social Studies Spanish, French, or other language Art Other OtherMy favorites things to do in the summertime* Go to camp Play a sport Read Sleep Go on vacation Swim Study Summer job Paly with my pet Other OtherIn studying the Bible, I would like to learn more about* Daily life in Bible times How the Bible applies to me today How the Bible applies to my family today How the Bible applies to my church today The meaning of hard-to-understand verses Vocabulary: what important words mean Science Fiction and the Bible Comparisons between the Old and New Testaments The life, death, and resurrection of Jesus Who wrote the book of James and why Baptism and the Church of the Brethren Creation, the book of Genesis, and caring for the earth Things in the Bible that the Church of the Brethren emphasizes The history of Christianity The relationship between faith and works The Sermon on the Mount The supernatural (angels, demons, miracles) Other OtherWhy do you want to participate in Immerse! this summer?*Parent/Guardian InformationParent/Guardian name* First Last Address* Street Address Address Line 2 City State ZIP Code Parent/Guardian primary phone*Type of phone*Cell PhoneLand line/Home PhoneWork PhoneParent/Guardian alternate phone*Type of phone*Cell PhoneLand line/Home PhoneWork PhoneParent/Guardian email* Enter E-mail Confirm E-mail Do you plan to attend Immerse! as an advisor?*YesNoWhile attending Immerse!, will your child be under the age of thirteen?*NoYesChild Online Privacy Protection Act*By checking this box, I give permission for my child to provide the personal information required to register for Immerse! I understand that I may contact Bethany Theological Seminary's program director of youth engagement 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*Name of pastor or youth group leader*Email of pastor or youth group leader* Enter E-mail Confirm E-mail Registration fee* $25 registration Fee By checking this box, you are acknowledging the $25 registration fee is required to attend Immerse! Please mail checks to Amy Marie Beery, Program Director of Youth Engagement, Bethany Theological Seminary, 615 National Road West, Richmond, IN 47374-4019You 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.Your child is NOT registered for Immerse!. Please contact our office at (765) 983-1809 to register your child in an alternate way. Questions? E-mail Amy Beery at the Youth Engagement Office. Call the office at 800-287-8822 or Amy’s cell at 317-418-6595. You’re welcome to text too!