2025 Billings Youth Rally

Teen's Name*

First NameLast Name

Age (as of the youth rally date)*

Teen's Cell Number

Format: (000) 000-0000.

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name*

First NameLast Name

Cell Number*

Format: (000) 000-0000.

E-mail*

example@example.com

Emergency Information (If different than Parent/Guardian)

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Please provide insurance information if available

Insurance Company/Provider

Policy Number

Do they have any allergies (food or pet), chronic illness, or medical conditions? If yes, please describe.

I do not need housing

Housing Request (Optional)

* We may not be able to accommodate these requests, but we'll try.

WHAT TO BRING: Bible, notebook & pen, sleeping bag, pillow, toiletries, towel, modest clothing/gym clothes*, water bottle, medications (if applicable) and especially a great attitude.

* Shorts, if worn, should approach the knees, no skin tight tops or bottoms, no halter tops, yoga pants or tank tops.

WHAT NOT TO BRING: Alcohol, drugs, nicotine products, vaping devices, or anything else that would distract you or others from having a great weekend.

Informed Consent and Acknowledgement

I give permission for the above participant to attend and participate in the 2025 Billings Youth Rally on October 17-19 to be held in Billings, Montana. I authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

I agree I shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.

Release of Liability

I hereby acknowledge that my child has voluntarily agreed to participate in the 2025 Billings Youth Rally, which involves indoor and outdoor related activities. I understand that these activities and all other hazards and exposures connected with these activities may involve risks, and I am aware of the possible risks and dangers inherent with such activities. I understand and agree that accidents or illness can occur and medical facilities, physicians, or surgeons may not always be readily available. I understand and agree that any bodily injury, death or loss of personal property and expenses thereof as a result of my child’s negligence in any scheduled or unscheduled activities associated with this event are my responsibilities. I agree to defend and hold harmless the participants and leaders of the 2024 Billings Youth Rally for any injury or death caused by or resulting from my child’s participation in the activities, scheduled and unscheduled, whether or not such injury or death was caused by their negligence or from any other cause.

Confirmation BY ACKNOWLEDGING AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

2025 Rally Registration & Consent Form