uLead Conference Registration

February 17th-19th (SC)
Parents Names:
Parents Email Address:
Phone Number:
Address:
City of Residence:
State:
Zip Code:
Student's Name:
Student's Email:
Student's Date of Birth: (mm/dd/yy)
Grade Level:
Age:
Gender: Male     Female
Student attends... Homeschool Private School Public School    
Will parents be attending? One Parent Both Parents No
Have you received Jesus Christ as your Lord and Savior? Yes No Not Sure
Do you attend youth group? Yes No
How did you hear about this uLead Conference?
If attending through a co-sponsoring group, which group?
Has the parent read, signed, and mailed the Medical Release Form? Yes No
Has the student read, signed, and mailed the Code of Conduct? Yes No

Thank you for registering! Signed Medical Release Forms and Code of Conduct are required for student attendence. They will be available to read and sign on Thursday at the conference.