WAITNG LIST - 2019 Disperse
July 14-17 • Evans, GA

DISPERSE IS FULL!

STEP 1: Please fill out the following information to be added to the waiting list. There are times where students drop out or are unable to attend Disperse. Things happen and spots open up.

If you have any questions, please contact Phil Coleman (phil@boredonsunday.com).

 

*Please use Firefox, Chrome or Safari.  If you have any technical questions, please contact web@ucumc.net.

STUDENT INFO
**used for communication and confirmation emails - check for typos**


ADDRESS


PARENT/GUARDIAN INFO
**used for communication and confirmation emails - check for typos**


STUDENT MEDICAL INFO

please mark if no allergy/medical needs
leave blank if none.


*PHOTO/VIDEO RELEASE

For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).



*TRANSPORTATION

I understand that my student will be transported via bus, by professional drivers, to Evans Georgia and other locations nearby.



*RELEASE

Submitting this on-line form will be the equivalent of signing a paper registration form.

  • I have read and understand the above information. The information I have given EPIC and University Carillon is accurate and true to the best of my knowledge.
  • My electronic signature signifies my understanding that submitting this online form will be the equivalent of signing a paper registration form.
  • I understand, no refunds are available for this event.


When this form is processed, you will receive a confirmation email. Thank you!