Leader’s Second Form | Youth For the Nations

GENERAL INFORMATION

Your Name*

First Last

Cell Phone Number*

Email Address*

Church Name*

Youth Pastor Name*

First Last

Gender*

MALE
FEMALE

Date of Birth*

MEDICAL INFORMATION

Do You Have Any Medical Conditions We Should Be Aware Of?*

YES
NO

If So, Please Describe Below

Do You Have Any Allergies We Should Be Aware Of?*

YES
NO

If So, Please Describe Below

Do You Have Any Dietary Restrictions?*

YES
NO

Special Notes/Requests:

Liability Release

By clicking "YES" below, you are agreeing to the following: Youth For the Nations, Christ For the Nations Inc., and all other affiliates of CFNI will not be held liable for any injuries that occur during your time of camp; You agree that any items lost or stolen are not CFNI or YFN's responsibility to find or replace; You are releasing Christ For the Nations Inc, Youth For the Nations, and all other affiliates of legal liability for any event that may take place during your time of camp; You are giving Youth For the Nations consent to make any medical decisions deemed necessary in the event of an emergency. Please click "YES" to agree.

*

YES
NO

By E-Signing my name below, I am stating that all the above information is accurate and I agree to the terms as stated above.

E-Signature*

First Last

Leaders Information

GENERAL INFORMATION

MEDICAL INFORMATION

Liability Release

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