HLVYth Conference Leader Registration

HLVYth Conference Leader Registration

Please book for your conference by filling the form below.
Full Name*

First NameLast Name
Sex*

MaleFemale
Birthday*

MonthDayYear
Date
E-mail*
example@example.com
Phone Number*
Church Affiliation*
I do hereby in this blank* day of blank* 2024, agree to take part in HLVYth Conference including activities such as, but not limited to group games, individual activities, and Christian spiritual services hosted by Harvest Life Victory Church Youth Group from November 15 to November 16, 2024.

I recognize it is a privilege for me to participate in this conference as a chaperone and I do hereby hold Harvest Life Victory Church, Harvest Life Victory Youth, their directors, employees, and all volunteer leaders involved indemnified from any and all liability whatsoever, which may arise because of, or in connection with this conference. I understand the risk of activities and agree to participate in activities that the HLVYth Conference entails. I hereby release all parties previously mentioned from any necessary medical cost.

Should any situation occur involving any kind of abuse or perceived abuse by a leader not affiliated with Harvest Life Victory Church, I do hereby agree to hold Harvest Life Victory Church, Harvest Life Victory Youth, their directors, employees, and all volunteer leaders, harmless from any and all present and future liability, actions, causes of actions, claims, expenses, and damages on account of injury, including death, to myself or my property.
Emergency Contact*
Emergency Contact Phone #*
Current Medical Conditions: (Include nature of any required attention, special needs, diseases, physical/mental limitation, medical conditions, and/or allergies to medication and otherwise.)*
Information concerning your ability to work with minors
Have you ever been investigated by the Child Welfare Agency or any other organization for suspected child abuse?*

YesNo
Have you ever been the defendant or respondent in a civil lawsuit or human rights complaint or other legal proceedings in which you were alleged to have abused or engaged in violence, harassment, or other immoral or illegal behaviour or conduct involving children, teens, or other vulnerable persons?*

YesNo
Pastoral/Ministerial Reference:
Full Name of Pastor/Ministry Leader*
Phone Number*
Email*
How long have you known this person?
By signing this, you are acknowledging that you have read and agree to all terms and conditions stated thus far and have answered honestly to each prompt on the first pages of this form.*

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I, blanks*hereby grant to Harvest Life Victory Church, their successors, and their assignees the right to record my image and/or voice and use the artwork and/ or written work, on video, on film, on photographs, in digital media, and in any other form of electronic or print medium and to edit such recording at their discretion.

I understand that my full name, address, and biographical information will not be made public. I further grant Harvest Life Victory Church, their successors, and their assignees the right to use, and to allow others to use, my image and/or voice on the internet, in brochures, and in any other medium and hereby consent to such use.

I hereby release Harvest Life Victory Church, their successors, and their assignees using my image and/or voice, artwork, and/or written work pursuant to this media release form from any and all claims, damages, liabilities, costs, and expenses which I or my child now have or may hereafter have by reason of any use thereof. I understand that the provisions of this release are legally binding. Please check one:
I consentI do not consent
Name of signee*
Signature*

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Date*

MonthDayYear
Date
Conference Workshop Sign-up

Please choose one workshop in each of the following sections which you would like to attend:
Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card.
Morning Workshops*

Mastering the Inner Storm: A Guide To Your ProcessSharing Your Faith as a TeenWhat Is The Bible For?
Optional Afternoon Ministry Workshops:*

The Heart of Leading WorshipNext Gen Ministry (Children's ministry)Walking In Your Call To Ministry*Check this box if you will not be attending a ministry workshop
Should be Empty:

HLVYth Conference Leader Registration

Information concerning your ability to work with minors

Pastoral/Ministerial Reference:

Conference Workshop Sign-up