Montreat Youth Conference 2024

June 9th- June 15th | Please fill out this form for the Montreat Youth Conference. You can pay the remainder of your balance here: https://downtownchurch.breezechms.com/form/52e247. Final payments due June 9th.

You can pay in full ($700 per youth) or you can pay a deposit of $250.

Contact Information

Name of Youth

*

Youth Birthdate

*

Name of Parent(s)/Guardian

*

Contact Email of Parent/Guardian

*

This address will receive a confirmation email

Parent /Guardian Phone

*

Emergency Contact Name

*

Emergency Contact Phone

*

T-Shirt Size

*

Please select one option.

YS YM YL S M L XL XXL

Health Information

Does your youth have any allergies?

*

Does your youth have any dietary restrictions?

*

Does your youth take any prescription drugs? If so please list name, dose, and frequency.

*

Is there any other medical information relevant for your child? (Lingering injuries, mental health, recent surgeries, ongoing medical issues, etc.)

*

Health Insurance Company

*

Policy Number

*

Scholarship $0

Deposit + Pay in full

deposit ($300) pay in full ($700) scholarship (0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 9th- June 15th

Please fill out this form for the Montreat Youth Conference. You can pay the remainder of your balance here: https://downtownchurch.breezechms.com/form/52e247. Final payments due June 9th.

You can pay in full ($700 per youth) or you can pay a deposit of $250.

Please Fix the Following

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