Portal | Elevate Individual Registration

Elevate Individual Registration Form

General Information
Emergency Contact Information
Medical Information
Waiver Upload

Elevate Youth Convention 2024

Individual Registration

IMPORTANT: Prior to completing this form make sure you have your health insurance information and your waiver form ready for upload; plus an email for your church leader.

Tip: Each time you press the Next button on this registration form your information will be saved. This means you can come back to this form at anytime and continue completing your registration. Once you have hit the Submit Form button, please reach out to the registrar team at ycregistrar@clba.org to make any changes to your registration.

First Name

Last Name

Gender

Male

Female

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone/Mobile

Personal Email

Church Email

Birthday

High School Graduation Year

Home Church (please include name & location)

T-Shirt Size

Emergency Contact Information

Emergency Contact #1

First Name

Last Name

Relationship to Attendee

Phone/Mobile #1

Phone/Mobile #2

Emergency Contact #2

First Name

Last Name

Relationship to Attendee

Phone/Mobile #1

Phone/Mobile #2

Medical Information

List all allergies and/or medical conditions that are important to know (i.e asthma, history of seizures, etc.):

Is this participant allowed to be given Benadryl?

Yes

Date of last Tetanus Immunization

Health Insurance

Please upload a picture/pdf of the front and back of they participant's health insurance card. You can upload a maxium of two items.

File Upload (you can upload a picture of pdf)

Choose File

Waiver Information

Please use the button below to upload completed waiver information.

File Upload (you can upload a picture or PDF)

Choose File