• Student Info

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  • Insurance Info

  • Health History

  • All attendees are expected to participate, not spectate, in ALL activities provided for them while at NYC. If your child has a medical illness or injury that would hinder them from participating in any activities, please send us the necessary information to avoid further issues.

  • Parent/ Guardian Info

  • Emergency Contact Info

  • By signing below I understand:

     My student will need an up to date Photo ID before the trip and a copy will be sent with
    this form


     Registration will be online and an email will be sent to complete registration.

     

     The parent(s)/guardian(s) MUST fill out the online registration form, regardless if the student is 18 or will be 18 at the time of the event. To do so you must use a parent(s)/guardian(s) email address.

     I understand that if I have filled out this form for the early bird price, but fail to register on planning center before October 15th, 2022, an extra charge of $75 will be added to my students sign up.


     Payments are to be made on time (refer to payment schedule on PDF Attached). Failure to do so could result in not participating.


     Money is not refundable due to pre-purchasing and ordering of items (flights, conference costs, hotel costs, etc.).

     

    Furthermore: 

    I, the parent or guardian do authorize the activity medic, any doctor, and/or hospital to administer medical treatment to my child. I authorize the use of any picture or video of my child in the reproduction of NYC advertisements, productions, or other uses of the District NYI council. I allow my child to participate in any activity while on the trip. I hereby release Northeastern Indiana District, Nazarene Denomination, directors, staff, agents, and sponsors from any and all liability for injury, loss, health, risk, damage, or death to person or property that may occur during the course of my child's involvement including but not limited to accidents and emergencies. I also agree to pick my child up from NYC and other trip locations upon being notified by the NYC director(s) that he/she has violated NYC rules and has become a serious disciplinary problem.

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