Youth Conference 2016 Registration Form
Youth Conference is going to be a blast this year! To register, completed this online form and submit payment to Heather Myers (2977 Pineville Road, McGaheysville, VA 22840). Registration is not considered complete until both a form and payment have been received. Once you take care of the details, all that is left to do is count down to Youth Conference! We cannot wait to see you this summer! :-)

Have questions? Contact Heather Myers at heather@mtolivebrethren.org.

The life of someone who follows Jesus is a life of risk and adventure. It's a life of wonder and amazement. It's a life that's very much not boring. Our theme for Engage 2016 is AS WE GO. Jesus followers were never meant to sit on the side lines. Following Jesus isn't a spectator sport. As we go through life, our lives--the way in which we live, speak, act, think, serve, work--is to reflect Jesus. 1 Chronicles 16:24 tells us to "Declare his glory among the nations, his marvelous deeds among all peoples." How we live, ought to declare Jesus. Throughout the week of Engage, we'll explore practically how we are to live as Jesus followers and discover what life looks like AS WE GO.
YOUTH INFORMATION
Full Name *
Your answer
Gender *
Required
Birthday *
Your answer
Age *
Your answer
Grade Starting in Fall '16 *
Required
Full Address *
Your answer
Parent/Guardian(s) Name(s) *
Your answer
Address (if different)
Your answer
Parent/Guardian(s) Primary Phone #(s) *
Your answer
Parent/Guardian(s) Email Address *
Your answer
First Time at Conference? *
Required
Adult T-Shirt Size *
Required
EMERGENCY AND MEDICAL INFORMATION
Emergency Contact #1 *
Your answer
Relationship to Youth *
Your answer
Phone # *
Your answer
Emergency Contact #2 *
Your answer
Relationship to Youth *
Your answer
Phone # *
Your answer
Insurance Company Name *
Your answer
Policy and/or Group # *
Your answer
Medical Conditions or Limitations (type N/A if none) *
Your answer
Current Medications: Prescription and Over-the-Counter (type N/A if none) *
Your answer
Allergies and Reactions: including medications, substances and food (type N/A if none) *
Your answer
PARENT/GUARDIAN CONSENTS
Medical Consent: It is understood that all reasonable safety precautions will be taken at all times by The Brethren Church Inc. I further release, indemnify, hold harmless and further discharge The Brethren Church Inc., it's employees and members, and the Engage Conference for any and all damages, losses or injuries sustained by participants resulting from applicant's participation in the Engage Conference. This extends and applies to, and also covers and includes, all unknown, unforeseen, unanticipated and unsuspected injuries, damages, losses and liability, and consequences in substance that releases shall not extend to claims, demands, injuries or damages which are unknown or unsuspected to exist at the time, to person executing such release are hereby expressly waived. (Checking "agree" is equivalent to signing your name.) *
Required
Photo Consent: I accept that any photographs, video and/or audio taken during the conference may be used for future promotional purpose via print, video and/or web. I understand a written request to exclude participant must be on file prior to the start of Engage Conference. (Checking "agree" is equivalent to signing your name.) *
Required
ENGAGE RULES
*Please visit the BYIC website and read over the Engage Rules and Guidelines with your youth. Verify that you have done so below.
Website: http://byic.org/engage-conference/advisor-info
My youth and I have read over the Engage Rules and Guidelines. I understand that by breaking any rules or guidelines during the week of Engage Conference participants may be sent home at their expense, regardless of cost or time remaining to the conference. (Checking "agree" is equivalent to signing your name.) *
Required
Date Submitted *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Mt. Olive Brethren Church. Report Abuse - Terms of Service - Additional Terms