2025 YCE CCPhilly REGISTRATION

July 10th – 12th

Youth Conference East (CCPhilly Registration)

By registering, you agree to be bound by the terms of Calvary Chapel of Philadelphia's Resolution on Participation in Church Activities.

Name(Required)

First Last

Email(Required)

Phone(Required)

Grade(Required)

Please enter a number from 9 to 12.

Date of Birth(Required)

School(Required)

Home Church(Required)

Parent/Guardian & Student Contract

Parent/Guardian Signature(Required)

Student Signature(Required)

Medical Release Form

Parent/Guardian(Required)

First Last

Parent/Guardian Phone Number(Required)

Parent/Guardian 2nd Phone Number(Required)

Please list any allergies, required medications, or pre-existing medical conditions(Required)

If needed, may we administer which of the following:(Required)

Tylenol

Advil

Aspirin

None of the above

Health Insurance Co.

Policy Number

Upload a photo of your insurance card

Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

not required, but is helpful.

Signature(Required)

Payment

The registration fee is $35 per person. If you need to change the quantity of attendees after you have registered, you can do so by calling the church office at 215-969-1520.

Total Cost per person

Price:

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Total Cost

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name