Name *
Address *
Phone *
Date of Birth *
Date of Birth
Please be specific. If multiple areas list them in order of importance.
Examples: Administration, Worship, Preaching, Serving, Sound, etc.
Emergency Info
Emergency Contact #1 *
Emergency Contact #1
Phone 1 *
Phone 1
Emergency Contact #2
Emergency Contact #2
Phone 2
Phone 2
If you are 17 or younger, you must have a parent or guardian fill this out on your behalf.
If your are not 18 years old or older than you MUST have your legal parent/guardian review and select "I agree" or "I disagree" on your behalf. I am either the parent/guardian of the pre-adult applicant or the adult applicant, and I understand that by selecting "I agree" in the options below, that I am agreeing that all of the above information is true and correct to the best of my knowledge. I also understand that by selecting "I agree" I am releasing Church of God, Romanian Territorial Office, and all other (if any) hosting organizations including the location of the event, or any other organization that is hosting this youth event, and their staff and lay-staff from all liability.