You`re Registration Form
Full Name: ____________________________________________________________________
Address: __________________________________City: __________________State: _______
Emergency Contact: _______________________________ Relationship: ______________
Home #: __________________ Cell #: __________________ Work #: _________________
T-Shirt Size: (circle one)
I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the person(s) listed on this form. In
the event I cannot be reached in an emergency during the activities at YAR 2015 (April 17-19), I hereby give my permission to the physician or dentist
selected by the NCDM leadership to hospitalize, to secure medical treatment and/or order an injection, anesthesia or surgery for me as deemed
I understand all reasonable safety precautions will be taken at all times by Discipleship Ministries and its agents during the events and activities. I
understand the possibility of unforeseen hazards and the inherent possibility of risk. I agree not to hold Discipleship
Ministries, its leaders, employees and volunteer staff liable for damages, losses, diseases or injuries incurred by the subject
of this form.
Mail your registration to :
NCDM – PO Box 60-Falcon, NC
ATTN: YAR 2015
NO Childcare will be provided
April 17-19, 2015
Ages 18 (out of High School) - 30ish
Young Adult Retreat
Join us for a weekend of fellowship!!
We are Super Excited about our first ever Young Adult
Retreat. Make plans now to be a part of this inaugural
event. We look forward to seeing you in Falcon
April 17th-19th, 2015.
Dr. Tracy Reynolds, Dean of the School of Christian Ministries, holds a
Doctorate degree in Strategic Leadership from Regent University as well as a
B.M.Ed. and M.M.Ed. from the University of Georgia. He has taught the gamut
of practical Christian ministries courses since coming to EC in 1998.
Dr. Reynolds began a career in music as a performer, songwriter, arranger
and instructor. He has served as a pastor in local churches for nearly 35
years. Pastor Tracy says, “My passion to train youth workers led me [from
being a youth pastor and music teacher] to Emmanuel College…. For the past several years, I
have served as dean of the School of Christian Ministries and continue to serve at Grace
Fellowship in Athens, Ga. Training next Generational leaders is my life mission. I am more
passionate than ever about reaching, teaching, training and unleashing the millennial
generation. It is my joy and honor to serve as we grow together to raise up the next generation
of leaders for the Kingdom of God.”
Music Led By:
HOP E TO SEE Y OU T HERE !
Brittanie Taylor is a majorly talented individual who uses her talents to lift up the name
above every other name, Jesus Christ! She has been leading worship along the
eastern side of the country for more than 10 years and has been involved in music
ministry the majority of her life. Brittanie is not afraid to stand and proclaim who she
serves and lets her light shine no matter where she is. Her spirit will touch you, her
boldness will sometimes shock you, but most of all, her kindness will reach you.
$60 Per Person
Make Checks payable to NCDM/YAR 2015
FOR QUESTIONS PLEASE EMAIL