Fullerton IV Momentum Spring 2020
Momentum is a conference for all returning* students at CSUF and FC. * Incoming freshmen & transfers are also welcome!

We gather before the semester starts because we want to reconnect as friends, spend time with God together, and prepare for New Student Outreach. It's a great way to reconnect with friends and get ready for the fall!

Friday, January 17 @ 7:00pm - Saturday, January 18 @ 7:00pm
Location: Canyon Hills Friends Church (20400 Fairmont Connector, Yorba Linda CA 92886)
Cost: $15 early bird before December 19th -- $20 for regular registration (12/20 and later)

We're glad you are coming with us! Please answer the following questions.
Your registration cost will cover your meals & materials for the retreat. You can pay in cash or Venmo when you arrive on Friday January 17th.
Information about You
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Gender *
Your answer
Current Student Status *
You can estimate if you aren't sure :P
When do you anticipate graduating (or transferring if in a CC)? *
e.g. "Spring 2022", etc.
Your answer
What campus are you coming from? *
Spiritual Background *
(e.g.: Not sure, Christian, Catholic, Agnostic, Muslim, Atheist, etc.)
Your answer
Are you able to drive to Momentum? *
If you can drive others, how many seat belts do you have? (including yourself)
Emergency Information
Name of Emergency Contact *
First & Last Name Please
Your answer
Relationship of Emergency Contact *
(e.g. Father, Sister, Friend)
Your answer
Emergency Contact Phone Number *
(###) ###-####
Your answer
Medical Insurance Provider
(or write "N/A" or "not sure")
Your answer
Medical Insurance ID Number
Your answer
Other Information
Any Food limitations/Allergies?
Your answer
Attendance? *
Missing a portion? What part are you missing? (when will you arrive late or leave early?) Also, please briefly mention why.
In general, we ask that you please attend the Entire conference, unless you have a specific need otherwise.
Your answer
Taking any medications?
If yes, please briefly state which ones, and if they require refrigeration.
Your answer
Release *
Please read this release and sign it below. If you do not agree to the terms of this release, you will be unable to participate in the event. 1. In consideration for being accepted and allowed to participate in this conference/project and activities associated with its program and location, I personally assume responsibility for my actions, and release InterVarsity Christian Fellowship/USA® (hereafter InterVarsity), its Trustees, employees and agents from loss, injury or damage to myself or my property; provided that nothing contained herein shall excuse InterVarsity, its Trustees, employees or agents from responsibility to act with reasonable care for the safety of myself or my property. 2. I give permission to InterVarsity to be photographed, recorded, and/or video taped and to allow this material to be used for publicity. 3. I give permission to InterVarsity to obtain medical assistance in the event of an emergency. This permission will include the administration of medicines, surgical treatment, X-ray examination or hospitalization as might be ordered by a licensed medical doctor. I release and discharge InterVarsity, its Trustees, employees, and agents from any liability for any first aid rendered or treatment performed pursuant to this consent. 4. I understand that InterVarsity has a hostage policy that states that InterVarsity should not yield to demands, including the payment of ransom or other extortion, issued through the use of hostage taking or extortion. 5. I am age 18 (19 in Alabama) or older. 6. Any claim or dispute arising from or related to this release shall be settled by mediation and, if necessary, legally binding arbitration in accordance with the rules of a mutually agreed upon alternative dispute resolution service. Judgment upon an arbitration decision may be entered in any court otherwise having jurisdiction. These methods shall be the sole remedy for any controversy or claim arising out of this release and I expressly waive my right to file a lawsuit in any civil court against InterVarsity for such dispute, except to enforce an arbitration decision. I certify that I am competent to sign this release, and have done so voluntarily.
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