Breakaway'23 Teen Coordinators
This form to be filled out by each Church's Teen Coordinator ONLY please!
*
indicates required
Name:
Email:
Comment:
Email Address
*
First Name
*
Last Name
*
Phone Number
*
Church Name
*
Church City
*
Which week will your church attend?
*
Week 1 - July 10-14
Week 2 - July 17-21
Undecided at this time
Approx. # of Male Students:
*
Approx. # of Male Adults:
*
Approx. # of Female Students:
*
Approx. # of Female Adults:
*
