TYC 2019 Participation Agreement
TYC 2019 Participation Agreement should be signed by each participating youth and their parents, if they are under 18. It gives permission for the youth to participate fully in all of the TYC 2019 activities being held on campus. This must be filled out prior to arrival at camp.

Name of Sponsoring Organization: Friends of Trinity Youth Conference
Address: 5 Perch Place, Lititz, PA 17543
Telephone: 724.448.7618
Name of Sponsor's Coordinator: Rev. Philip Beck
Telephone (same as above)
Description of Activity: Activities included but not limited to the attached scheduled activities for TYC 2019
Dates/Location of Activity: Sunday, July 21 (4:30 pm) through Saturday, July 27 (12:00 pm); at Living Waters Camp and Conference Center (300 Living Waters Road, Schellsburg, PA 15559; 814.733.4212).
Email address *
Name of Participant *
Your answer
Name of Parent(s)/Guardian(s)
Your answer
Address of Participant *
Your answer
Phone Number of Participant *
Your answer
Name of Emergency Contact *
Your answer
Emergency Contact Phone Number (Day) *
Your answer
Emergency Contact Phone Number (Night) *
Your answer
I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the activity described above (the “Activity”), the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association. *
Participant Signature (In typing your name, you are giving your signature as permission.) *
Your answer
Parent/Guardian Signature, if under 18 (In typing your name, you are giving your signature as permission.)
Your answer
A copy of your responses will be emailed to the address you provided.
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