Youth Leader Registration

Youth Leader Information

First Name

Last Name

Cell Phone

Church Information

Church Name

Mailing Address

City

State

Zip Code

Church Phone

Workcamp Information

Workcamp

Estimated number of Adults you will bring

Participants that are age 21 or older

Estimated number of Youth you will bring

Enter the number of participants that are currently in 7th grade up to age 20

Special Circumstances

Please note the following in "Special Circumstances":

Any members of your group who have a mental health, emotional, or physical special needs.
If there is a requirement that your group work together in crews made up of people only from your church.
Any members of your youth group that you prefer are placed on a crew with an adult from your church.
Anything else that TeenServe should know about your group.

Where did you hear about TeenServe?

If "Other", please specify below