Youth Evangelism Conference Registration

2024 Youth Evangelism Conference

Family Information

This will be used to send a copy of this registration form, and other important trip updates
This will be used to send a copy of this registration form, and other important trip updates

Trip Information

Deposit of $50 by December 15 for early bird special. Remainder of cost due before retreat.
If paying by credit card, use your MPBC App or pay on our website (this link will be in your confirmation email). Please forward the payment receipt to - this will help us greatly!
If paying by cash/check, put in envelope in Black Box by church office door.
More than one request can be added, but only the first one will be guaranteed
Do you have a 2023 Medical/Travel release on file? *
Even though you have filled out a medical release from 2023, we will need a new medical release for 2024.

Medical Release Information

If you choose one, a text box for more information will appear.

Medical & Travel Release

The paper Registration and Medical Release form will be created with the information on this digital form. It will need to be signed by a parent or guardian at camp check in. Separate release for StudentLife Camps will also be required.

The following release will be included:
"My permission is granted for any Mount Pleasant Baptist Church staff member or sponsor in charge of the Student Life Camp to obtain medical attention in case of sickness or injury for (student's name).

"I/We, the undersigned, do hereby release, remise and forever discharge all sponsors and Mount Pleasant Baptist Church, Colonial Heights, Virginia, from any and all claims, demands, actions, or cause of action, past, present, or future arising out of any damage or injury while participating in this event. I also agree to pick up my student or reimburse MPBC for the cost of sending my student home in the event that he/she commits any infraction of the rules, puts their fellow participants in danger, or exhibits a disruptive attitude."

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