FLY 2019 Registration

Due to limited seating capacity in the Longhouse, those registered as adults and/or children are expected to attend evening sessions in the overflow location in Assembly Hall. Students, Dorm Room Leaders, and youth workers are required to attend evening sessions in the Longhouse.

By applying, I affirm that I am committed to:

I will be responsibile to carry out my duties in this role.
I will serve alongside staff in my area, and respect the leadership structure of the FLY Committee.
I will lay aside personal preference to invest sacrificially in the position I am serving in.
I will cheerfully comply with all FLY regulations, setting positive examples for students.
I will respect the distinctives of Biblical Lutheranism as set forth by the AFLC.
I will pray for students before, during, and for one week after the FLY Convention.

Gender Dysphoria policy here
*By providing your cell phone number you are agreeing to receive FLY/Youth Ministry text messages

Emergency Contact

Church Information

Other Church Information

Church Address

Pastor Information

Youth Leader

Image Release

I/We understand that by registering for the FLY Convention, the registrant may have photos or video taken of them. I release and understand that those pictures and video may be used in various ways, which include social media posts during the week of FLY, videos shown at FLY, and FLY Convention promotional videos in future use. I/We understand that no reference to my child’s name would be made alongside such images.

If you do not give your release, please click “no.” By clicking no, you understand that as pictures and videos are taken, it is challenging for our staff to know who you are, and henceforth agree to not put yourself in situations where pictures and videos are taken.

Medical Release

I herein authorize the adult sponsors of the Free Lutheran Youth Convention to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care, to be rendered to the minor under the state of treatment, when the need for such treatment is immediate and when efforts to contact me (us) are unsuccessful. This includes the administration of Benadryl, Tylenol, or Ibuprofen if needed as perceived by the First Aid team.

By checking this box you are agreeing to the conditions above, are legally responsible for the minor and are affixing your digital approval to this agreement.

Health Insurance

Health Insurance Info

*Note that in order for this registration to be complete, if you have medical insurance, the insurance card must be uploaded at this time. We do not accept mailed or emailed insurance cards.
Drop a file here or click to upload Choose File
Maximum upload size: 8.39MB
Drop a file here or click to upload Choose File
Maximum upload size: 8.39MB

Health Information

(If needed, a student's Dorm Room Leader will be responsible for seeing that medications are taken. This cannot be the responsibility of the First Aid Team.)
(Adults will be responsible for the medication schedule of children under 11 attending FLY. This field is for our first aid team in the instance of emergency.)

Background Check

You will not be approved until the background check has been completed. You will be contacted via email by our background check company, Trusted Employees within 30 days.

(This form authorizes the church/organization to obtain background information and must be completed by the applicant. The church/organiztion must keep this completed form on file for at least two years after requesting a background check.)

I, the undersigned applicant (also known as "customer"), authorize FLY through an independent contractor, to procure background information (also known as a "consumer report and/or investigative consumer report") about me. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records.

I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to FLY if such is made within a reasonable time and from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.

By checking this box you are agreeing to the conditions above, and are affixing your digital approval to this agreement.


Please list two character references, including City, State, and Phone Number


Personal Experience

Please answer the following questions.

Payment Information

$ 00
$ 00
$ 00
$ 00

Credit Card Information

Credit Card
Card Number
Exp. Month
Exp. Year
Billing Address


This check # is for the deposit/full payment made at registration. The amount of this check is already taken into account with the "Amount Due Now" above.
$ 00
The amount due now when they register.
This check # is for a payment made after registeration. The amount should be entered in the "Stripe/Check Amount Received" below.
This is the invoice # generated by Stripe when an invoice was sent to receive a credit card payment after registration. The amount should be entered in the "Stripe/Check Amount Received" below.
$ 00
$ 00