Register for the Evolve Conference
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Registration Info
Personal Information
Last Name*
First Name*
Middle Init*
Home Address*
City*
State*
Zip*
Country* Check if U.S.
Phone 1*
Phone 2
Email*
Church: Check if Allen*
Pastor: Check if Rev.Dr.Floyd Flake*
Emergency Contact
Is the emergency contact the same as the guardian?    Yes       No    
First Name*
Last Name*
Emergency Contact Phone*
Emergency Contact Relationship*
Comments
Child/Children Information

All child fields are required except for email and middle initial. Only children ages 12 to 18 can be added. Use the X to remove a child.

1. Last name* First name* MI Age* Class*
×
  Email Phone* Grade* School* T-Shirt*
 
Statement of release
I hereby authorize the participation of the above children in activities of the Shekinah Youth Church of the Greater Allen A.M.E. Cathedral of New York - Evolve event series. In consideration of the Shekinah Youth Church providing these activities, I, on behalf of myself and other parents and guardians of the minor, do hereby release the Shekinah Youth Church and thereby the Greater Allen A.M.E. Cathedral of New York, it’s officers, employees, and agents from all claims and causes of action by reason of any injury which may be sustained as a result of these event activities, whether on the church premises or on the way to or from these activities. I agree to the aforementioned to cooperate and to conform to directions and instructions of personnel of the organization in charge of these activities. Should this individual choose not to do so, and should those leading an activity believe it necessary, I will come and remove my child from the activity as soon as possible after being called by a staff or representative for that purpose.
   Accept    

I hereby give my permission to The Shekinah Youth Church of the Greater Allen A.M.E. Cathedral of New York to secure a physician, nurse, or dentist for the purpose of providing emergency medical or dental aid, including transportation to and from necessary facilities, as may be required by the illness or injury of the above named individual(s). I further agree that I will not hold the Greater Allen A.M.E. Cathedral and the Shekinah Youth Church responsible or liable for its action taken in such an emergency situation. This authorization shall remain effective until revoked in writing delivered to the Shekinah Youth Church.
   Accept    
Signature
Please type your name*
 
8/22/2018 12:11:59 AM

REFUND POLICY

  • FULL REFUND: If Cancelled By or Before 7/25/2018. 
  • 50% REFUND: If Cancelled by 8/1/2018. 
  • NO REFUNDS: If Cancelled After 8/1/2018.

CHECK POLICY

  • NO PERSONAL CHECKS ACCEPTED AFTER 8/1/2018.
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