Registrant Info

Are you registering a leader or a student? *

Leader
Student

Leader First Name *

Leader Last Name *

Leader Preferred Name (if applicable)

Leader Email *

Leader Phone Number *

Relationship to students *

Affiliation *

Students' Names (if known)

Student Info

Student First Name *

Student Last Name *

Student Preferred Name (if applicable)

Student Email *

Student Sex *

Student Grade *

What church does the student attend, if any?

What are the student's post-secondary plans, if any?

Parent Info

Parent First Name *

Parent Last Name *

Parent Email *

Parent Phone Number *

Is the parent listed above the Emergency Contact? *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Relationship to the Student *

Emergency Contact Phone Number *

Please check this box if the Parent(s) would be interested in attending our Parent Equipping Session on the morning of the Western Youth Summit.

Checking this box does not confirm your attendance. Those who indicate that they are interested will be sent more information closer to the event date on May 23, 2026.

Dietary Restrictions

Seats at breakout sessions will be first come, first served. Choosing a session below doesn't guarantee your spot, and you are free to change your mind on the day. Your choice will help us assign rooms based on the level of interest in each topic.

Breakout Session 1 *

Breakout Session 2 *

Want to make changes to your form after submission? Please do not submit a new registration form. Instead, please email lindsay@apologeticscanada.com

I understand that registrations are refundable up to May 8, 2026.

Would you like to register another individual?

Registrant Info

(2) Are you registering a leader or a student? *

Leader
Student

Leader First Name *

Leader Last Name *

Leader Preferred Name (if applicable)

Leader Email *

Leader Phone Number *

Relationship to students *

Affiliation *

Students' Names (if known)

Student Info

Student First Name *

Student Last Name *

Student Preferred Name (if applicable)

Student Email *

Student Sex *

Student Grade *

What church does the student attend, if any?

What are the student's post-secondary plans, if any?

Parent Info

Parent First Name *

Parent Last Name *

Parent Email *

Parent Phone Number *

Is the parent listed above the Emergency Contact? *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Relationship to the Student *

Emergency Contact Phone Number *

Please check this box if the Parent(s) would be interested in attending our Parent Equipping Session on the morning of the Western Youth Summit.

Checking this box does not confirm your attendance. Those who indicate that they are interested will be sent more information closer to the event date on May 23, 2026.

Dietary Restrictions

Breakout Session 1 *

Breakout Session 2 *

Want to make changes to your form after submission? Please do not submit a new registration form. Instead, please email lindsay@apologeticscanada.com

I understand that registrations are refundable up to May 8, 2026.

Would you like to register another individual?

Registrant Info

(3) Are you registering a leader or a student? *

Leader
Student

Leader First Name *

Leader Last Name *

Leader Preferred Name (if applicable)

Leader Email *

Leader Phone Number *

Relationship to students *

Affiliation *

Students' Names (if known)

Student Info

Student First name *

Student Last name *

Student Preferred Name (if applicable)

Student Email *

Student Sex *

Student Grade *

What church does the student attend, if any?

What are the student's post-secondary plans, if any?

Parent Info

Parent First Name *

Parent Last Name *

Parent Email *

Parent Phone Numer *

Is the parent listed above the Emergency Contact? *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Relationship to the Student *

Emergency Contact Phone Number *

Please check this box if the Parent(s) would be interested in attending our Parent Equipping Session on the morning of the Western Youth Summit.

Checking this box does not confirm your attendance. Those who indicate that they are interested will be sent more information closer to the event date on May 23, 2026.

Dietary Restrictions

Breakout Session 1 *

Breakout Session 2 *

Want to make changes to your form after submission? Please do not submit a new registration form. Instead, please email lindsay@apologeticscanada.com

I understand that registrations are refundable up to May 8, 2026.

Order Details

We will use this information to pair the tickets and registration forms.

Name of Purchaser *

Order Number *

Thank you for your submission!

Thank you for completing the registration! We look forward to seeing you at this year's Western Youth Summit!

Thank you for your submission!

Thank you for completing the registration! We look forward to seeing you at this year's Western Youth Summit!

Western Youth Summit 2026

Registrant Info

Student Info

Parent Info

Registrant Info

Student Info

Parent Info

Registrant Info

Student Info

Parent Info

Order Details