Central Iowa Teens Encounter Christ

Central Iowa Teens Encounter Christ

Youth Candidate Application
TEC #76

November 19-21, 2021

Location:

Lynnville Friends Church

503 East St

Lynnville, IA 50153

Candidates are expected to be present for the entire weekend (from Friday at 10 a.m.-6:00 p.m. on Sunday). This will include an absence from school.

Applications are accepted for candidates beginning the summer before their sophmore year of high school though the summer after their senior year.

Primary contact will be made to the parent email and students will also receve a seperate email. Please let us know ASAP if either of you DO NOT receive this email!
Last Name *
First Name *
Name to be called if different from above.
Gender *

Male Female
Address *
City *
State *
Zip *
Email *
You should get a follow up e-mail. Send us an email if you do not!
Student Cell Phone *

Area Code Phone Number
Home Phone

Area Code Phone Number
School *
Birth date *
Class of *
Shirt Size *

Small Medium Large Extra Large Extra Extra Large
Who told you about TEC? (Name names!)
If applicable:
Church
City
Parent or Legal Guardian Information
Parent/Legal Guardian *
Parents Email *
You should get a follow up email. Let is know if you do not.
Parent Home Phone *

Area Code Phone Number
Primary Cell Phone *

Area Code Phone Number
Secondary Cell Phone

Area Code Phone Number
Secondary Cell Owner

First Name Last Name
I, recognize that churches and dominations have varied views on who may take communion. I understand that communion will be served during the TEC weekend and give permission to my son/daughter to make the decision whether or not to participate. *

Yes NO
Health Information

In the event of a medical EMERGENCY, I hereby grant permission to the physician selected by the TEC leadership to secure proper treatment for my child as named above. I certify that there is no guarantee or assurance has been made as to the result that may be obtained.
Medical Insurance Company *
Policy Number *
Medical/Allergy/ Dietary/Special Needs *
Photo Release
I agree that photos of my child can be taken on used on for TEC social media purposes

Yes No
Payment Information

$50 Payment is due at or before the TEC weekend.
Payment Options:
prev next ( X )
Send a Check $50 (No Processing Fee) to Wendy Sims @ 384 223rd Place Pella IA 50219 (separate from parent letter) Free

PayPal (or Credit Card) Registration + Processing and Registration Fee $ 51.00

My Church pays for my registration (This MUST be confirmed with church)($50) Free

Give payment to an adult at TEC drop off Free

Total $ 0.00
Parents Electronic Signature. *
Date

Month Day Year
Date
Please check the Student and Parent email for important information for you both. Let us know if you DO NOT receive it!

We are excited to meet your student!!

Please join us in prayer for the weekend!!
Should be Empty:

Central Iowa Teens Encounter Christ

Parent or Legal Guardian Information

Health Information

Photo Release

Payment Information