LOGOS Registration Test | Reformed Youth Services

Please note, your significant other must register separately.

I am registering as a:

Significant Other's Name

Would you like to go on the Dells Boat Tour? (+$30)

LOGOS Store

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ATTENTION

Hats selected will only be available for
individuals who registered before June 4.

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Would you like a hat? (+$15)

Choose your style of cap

Choose your logo

Choose your hat color

General Information

Please let us know a little bit about yourself.

Your Church

Title

First Name

Last Name

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone/Mobile

Gender

Male

Female

Birth Date

LOGOS Questions

Dorm Assignment (FOR ADMIN)

Lewis

Burgess

Krause

Scott

Roommate Choice (list one or two roommates, or potluck) If you are married please list your spouse.

Please include your occupation or college name

Would you be willing to be a small group leader?

Yes

No

Emergency Contact Information

We will contact this individual if there is an emergency need.

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Email

Emergency Contact Phone

Emergency Contact Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Emergency Contact's Relationship to Registrant

What should we know about the registrant if there's an emergency?

Please list any special needs we may need to know about (eg. wheelchair access, etc.)

Does the registrant have / had allergies?

Yes

No

Please explain your allergies

Does the registrant have / had medical conditions?

Yes

No

Please explain your medical condition(s)

Current Medications and Dosage(s)

I do not have insurance at this time

Insurance Company

Insurance Policy Number

Insurance Group Number

I certify that the information on this form is true to the best of my knowledge. I understand that every effort will be made to contact me, but I do hereby give my permission for the LOGOS staff or any licensed physician to render emergency medical care in the event of a medical emergency. I hereby release Reformed Youth Services, its employees, volunteers, and other youth leaders from any liability for any claims of damages or injury to myself. I understand that by signing this agreement, I absolve Reformed Youth Services, its employees, volunteers and other youth leaders for any liability for any claims of damages or injury to myself and my property for any injury or damages that may occur, including serious injury or death. I also agree not to sue Reformed Youth Services, its employees, volunteers and other youth leaders for any liability for any claims of damages or injury to myself or my property. I have read this release and agreement not to sue. I understand it and I am bound by its provisions. * Please type your name.*

Room Assignment (FOR ADMIN)

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Click the Continue to Payment button below and you will be sent to PayPal for payment. Be sure to click Return to Merchant at the end so we can finish processing your registration.

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