RELEASE FORM | Youth For the Nations

Which week are you attending?*

Week 1: June 11-15
Week 2: June 18-22
Week 3: June 25-29
Week 4: July 2-6

Please select your registrant type:*

Registrant Information

Name*

First Last

Sex:*

Female
Male

Age*

Email*

Phone*

Parent/Guardian Information

*** Please notify us if the parent is not the primary emergency contact!

Parent/Guardian Name*

First Last

Parent/Guardian Email*

Parent/Guardian Phone*

Church Information

If registering with a church, please provide church information.

Church Name

Youth Pastor Name*

First Last

Youth Pastor Phone

Youth Pastor Email

Medical Information

List any diseases, physical or mental limitations:*

List any current medications and their purpose:*

Allergies and Descriptions (food, medical/medicine, insects, etc.):*

Other: (Any important medical and/or any information we should be aware.)

Nurse Authorization:

I the parent/guardian give YFN Summer Camp's Nurse and/or my church's Youth Pastor permission to administer these medication as needed and directed on the medication container.

Ibuprofen
Benadryl
Tylenol
Bandages

Nurse Authorization*

Yes
No

Please Note:

*In order to be fully registered, all individuals under who are under 18 will have to fill out the YFN Medical Immunization/Shot Record Release Form.

Medical Release:

MEDICAL SHOT RELEASE:

*In order to be fully registered, all individuals under who are under 18 will have to fill out the YFN Medical Shot Release Form.

I, The parent/legal guardian of hereby release Christ For The Nations or Youth For The Nations and all parties involve of any liability regarding the recording of my child’s shot records during YFN 2018. I acknowledge that my child is completely up to date on all shots and immunizations and or that I will not hold Christ for the Nations or Youth for the Nations liable.

MEDICAL IMMUNIZATION/SHOT RECORD RELEASE:

Yes
No

MEDICAL SHOT RELEASE: *In order to be fully registered, all individuals under who are under 18 will have to fill out the YFN Medical Shot Release Form. I, The parent/legal guardian of hereby release Christ For The Nations or Youth For The Nations and all parties involve of any liability regarding the recording of my child’s shot records during YFN 2018. I acknowledge that my child is completely up to date on all shots and immunizations and or that I will not hold Christ for the Nations or Youth for the Nations liable.

Release of Liability

I. I hereby waive, discharge, and release Christ For The Nations, Inc., Christ For The Nations Institute, Youth For The Nations and all employees, from any and all damages, injuries, property damages, claims, loss, death, demands or causes of action that I or any family member heirs, executors or administrators may have arising out of this event.

II. I agree to conduct myself in accordance with the Code of Conduct, rules, dress code, beliefs, and standards of behavior that are expected of me during my week as a campus guest at YFN. I will also abide by the various instructions and guidance I am giving Christ For The Nations, Inc., Christ For The Nations Institute and/or YFN.

III. I do not suffer from a physical or mental impairment that would limit my ability to participate in this event. I understand, agree and hereby release permission to authorize emergency medical treatment for me, if necessary. I understand and agree that Christ For The Nations, Inc., Christ For The Nations Institute, will assume no responsibility for any injury or damage which arises out of or in connections with such authorized emergency medical treatment.

THIS IS A LEGAL AGREEMENT. PLEASE READ FORM CAREFULLY AND BE CONFIDENT YOU UNDERSTAND IT BEFORE SIGNING.

RELEASE OF LIABILITY ACCEPTANCE:*

Yes
No

I understand that parents/legal guardian are responsible for signing any forms that require a minor's signature:

Yes
No

Pastor E-Signature*

Pastor Spouse E-Signature*

Camper/Leader E-Signature*

Parent/Guardian E-Signature*