EPIC — CONVERGE 2023 — WAITING LIST – University Carillon Forms

June 26-30, 2023

CONVERGE 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 Converge. Things happen and spots open up.

If you have any questions, please contact Holly Fohr & Terri Hall (epic@universitycarillon.net).

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

YOUTH INFO

student name

First Name *

Last Name *

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Upcoming Grade (23-24) *

Student Email

PARENT/GUARDIAN INFO

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Parent/Guardian Name *

Cell *

Parent Email *

Confirm Email

*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, I DO NOT pay until contacted that a spot is available.

Release *

Yes, I agree

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Student Electronic Signature *

Parent/Guardian Electronic Signature *

Date *

After submitting your form, WATCH FOR Confirmation Email.

These will let you know your Card is complete.

One from our web specialist with the responses from your registration.

Save and Resume Later