Young People

s Ministry Event Group Checkoff Form

Address: ____________________________

___________________________________________

City, State, Zip Code: ____________________

________________________________________

Youth Min -

Home:

(_____)________

__Cell: (_____)_____________Work: (_____)_____________

Church Name: ____________________________

_______________________________________

Pastor: ____________________________

Youth Minister: ___

___________________________CL (Clarksville)CO (Columbia)CK (Cookeville)CU (Cumberland)MU (Murfreesboro)NA (Nashville)

District (circle one)

PU (Pulaski)

Name of RegistrantAdult/ YouthHealth FormPayment

This form should accompany all registration forms for the event which you are registering. Make morecopies of this form as needed. Please be sure to place this on the top of your registrations.

EVENT:___________________________________

___Today

s Date:_________________________Number of Participants (Including Adults) ________ X ________(Fee) = $ ____________

Before November 29 - $45



After 11.29 before 12.29 - $50



After 12.29 before 1.20 - $55



After 1.20 - $65



Not accepted after 1.25



No Refunds after 1.15

Make Checks payable to

Tennessee Conference Young People

s Ministry

Mail to: Warmth In Winter, TN Conference UMC304 S. Perimeter Park Drive, Suite 1Nashville, TN 37211

Young People

s Ministry Event Registration Form

Utilize this registration form for all events sponsored by the Young People

s Ministry of the TennesseeConference of The United Methodist Church. A completed form only needs to be submitted one timeper year unless health or insurance information changes. ALL PARTICIPANTS BOTH YOUTH ANDADULT must submit a completed form for the ﬁrst event attended during the ministry year. Thisinformation will be entered into a secure database at the Tennessee Conference Ofﬁce and utilized asneeded for health and registration information. Your information will not be given or sold to anotherparty for use of any kind.

Please Print or Type Clearly

Today

s Date _________________________

Event You Are Registering For: ____________________________

_________________________

Participant Full Name: ____________________________

______Email: _____________________

Address: ____________________________

___________________________________________

City, State, Zip Code: ____________________

________________________________________

PHONE -

Home:

(_____)__________

__Cell: (_____)_____________Work: (_____)_____________

Church Name: ____________________________

City/State: ___

_________________________

Pastor: ____________________________

Youth Minister: ___

___________________________

If non-Tennessee Conference UMC, name of other Conference, Denomination or ReligiousAfﬁliation: __________________________________________________________School (Currently attending): _____________

__________________________________________

DOB: _____________ Age: ______ Current Grade Level:______ Gender:____ Race:__________If under age 18, Parent or Guardian of Registrant:

Name(s): _________________________________________________________Parent Signature: __________________________________________________Address if different from above: _______________________________________City, State, Zip Code if different from above: _____________________________Phone: Day (______)_________________ Evening: (______)_______________Cell: (_______)__________________ Email:_____________________________

COMPLETE THE OTHER SIDE, PLEASE