EMBOLDEN 2023 Registration

EMBOLDEN 2023 Registration


Date: Friday, November 17 - Sunday, November 19
Time: 7pm Friday - 12pm Sunday (transportation times will be communicated by your Youth Minister)
Location: Camp Tecumseh in Pittstown, NJ
Who: All high school teens are welcome!
Cost: $175 (plus $25.00 late registration fee after November 10)

For questions, please contact Jean Stroud at jstroud@fiatventures.com

Payment Option:

Participant Information

*First Name
*Last Name
Apartment If Applicable
*Zip Code
*Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)
*Shirt Size

Parent/Guardian Information

First Name
Last Name
Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)
*Allergies and any medication you will be taking during the event

Emergency Contact Information

*First and Last Name
*Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)

Additional Information



Are you currently under the care of a physician, being treated for a chronic condition, or on prescribed medication? Do you have any food allergies or special food needs that we should be aware of?

Please hit button only once:

P.O Box 4292, Warren, NJ 07059