Fall Encounter Group Form 2024

This form is to be filled out by your Pastor or Youth Pastor only. If there are more students in your group that are not listed in your first submission, please fill out an additional form that includes ONLY the students that have NOT been listed yet.

Church
Pastor Pastor First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Youth Pastor (if applicable) Youth Pastor (if applicable) First Last
NUMBER of Students & Leaders
I acknowledge that it is my responsibility as the individual filling this form out to instruct the parents, students, and leaders who are attending the lock-in to fill out a waiver form that is located on the bottom of impactmi.pcg/fallencounter.

I acknowledge that it is my responsibility as the individual filling this form out to instruct the parents, students, and leaders who are attending the lock-in to fill out a waiver form that is located on the bottom of impactmi.pcg/fallencounter. I acknowledge
List of NAMES of Students and Leaders
Name of individual filling out form (must be 18+ to complete form) Name of individual filling out form (must be 18+ to complete form) First Last
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.