Oasis Conference Registration 2024

Student Registration Form & Adult Release Form Please bring all completed forms with you on first

Name*

Student First NameLast Name

Address*

Address

Street Address Line 2

City

State*

Zip*

Email*

example@example.com

Adult Leader/Student Cell Phone Number (put all 0s if you do not have aphone.*

Please enter a valid phone number.

High School Graduation Year (Students Only)

Sex (M/F)*

Church Name*

If your church is a First Christian Church or denomination, please give us the town or city your church is in as well as the church name in this line.

City*

State*

Youth Leader Name*

This is the main contact person for your group that will be at the event.

I am the Youth Leader in charge of bringing students for my church.*

YesNo

Name of Parent or Legal Guardian*

Use own name if you are an adult leader

Home Phone*

Emergency Phone*

Secondary Contact to notify in event of emergency*

Relationship to Student or Leader*

Contact Phone*

Parental Consent (REQUIRED)

Emergency Authorization -

In the event of an emergency where neither the secondary contact nor myself can be reached, I hereby give permission to the physician selected by the participant's Church sponsor or OASIS staff to order X-rays, routine tests, secure proper treatment, hospitalize, order injections and/or anesthesia and/or surgery for my child as named above.

I further authorize the release of the above medical information to appropriate medical personnel and/or the health coverage insurance company. In addition, I have and do hereby, release OASIS, its directors, employees, or agents from liability associated with participation in OASIS.

Photo Release - This document serves as a release for my child to appear in photographs and/or videotapes while participating in OASIS for the purposes of publicity, staff training, and/or promotion.

Information Release - This form also releases contact information to the team of student ambassadors at Manhattan Christian College to encourage your students via a courtesy text, email, or phone call. MCC will not sell or otherwise giveaway any private information.

Name of Student*

Insurance Information Primary Insured

Insurance Company

Phone

Policy #

Please list any allergies or special medical problems your child may have. (Put none if there are none)*

This student or leader may be given over the counter medication*

YesNo

Signature of Parent/Legal Guardian, (if you are an adult leader then sign for yourself)*

Date*

Date