2019 EPIC Middle School Camp - HS Leader
EPIC • July 29-Aug 2 • 9am-1pm

COST: $10 per HS Leader.

STEP 1: Please complete one registration form per HS Leader.

*Please use Firefox, Chrome or Safari.  If you have any technical questions, please contact web@ucumc.net.

STUDENT INFO
**used for communication and confirmation emails - check for typos**


ADDRESS


PARENT/GUARDIAN INFO
**used for communication and confirmation emails - check for typos**


STUDENT MEDICAL INFO
please mark if no allergy/medical needs
leave blank if none.


TIME AWAY
leave blank if none


BRIGHT FUTURES


*PHOTO/VIDEO RELEASE

For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for EPIC and University Carillon use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).



*RELEASE

Submitting this on-line form will be the equivalent of signing a paper registration form.

  • I have read and understand the above information. The information I have given EPIC and University Carillon is accurate and true to the best of my knowledge.
  • My electronic signature signifies my understanding that submitting this online form will be the equivalent of signing a paper registration form.
  • I understand, no refunds are available for this event.
Due upon registration.


When this form is processed, you will receive a confirmation email with payment instructions. Thank you!