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General Information Document
"
*
" indicates required fields
Registration Form
Home Church Name & City
First Name
*
Last Name
*
Age
*
(Students Only) Last Grade Completed
Gender
*
Male
Female
T-Shirt Size
*
Medium
Large
X Large
XX Large
No smalls available
Participant Agreement
*
I agree to the following terms
I have read the general information document, and understand what is expected of me at the Faith Into Action Youth Conference & Family Festival. I will have a good attitude, not complain, and be respectful to others throughout the entire week.
Block Party Area
Please select your top 3 choices. We will do our best to place you in one of these areas
Food
Inflatables
Prizes
Games
Registration
Medical Release
Name
*
First
Middle
Last
Date of Birth
*
MM slash DD slash YYYY
Emergency Contact: Parent/Guardian/Spouse Name
*
Home Phone
*
Cell Phone
Work Phone
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
*
Medical Insurance Company
*
Policy Number
*
Secondary Emergency Contact Name
*
Relationship
*
Home Phone
*
Cell Phone
Work Phone
Emergency Agreement
*
I agree to the following terms
In case of emergency, I give the leadership of the Faith Into Action Youth Conference & Family Festival permission to act in what they feel to be the best interest of my child's health. In the event that I am/my child is injured and require(s) the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician.
Medication Agreement
*
I agree to the following terms
Students requiring medications must bring (1) all medications in original containers, (2) a written list of all medications and (3) basic instructions for intake. For safety reasons, medications will be collected upon arrival and administered daily by adult staff. This includes all over the counter medications as well.
Medication Agreement
*
I agree to the following terms
Students requiring medications must bring (1) all medications in original containers, (2) a written list of all medications and (3) basic instructions for intake. For safety reasons, medications will be collected upon arrival and administered daily by adult staff. This includes all over the counter medications as well.
Parent/Guardian Signature (student consent) or Adult Signature (self-consent)
*
By typing your name, you agree to the terms and conditions.
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