Fall 2024 GA/AL/TN YP Conference Registration and Medical Release Forms

2024 Fall YP Conference WAITING LIST

The Churches in Georgia, Alabama, and Tennessee
When: Friday, November 1 - Lord's Day, November 3, 2024

Where: Fort Mountain Retreat Center, Chatsworth, GA

Cost: $150 per YP and serving one

Registration deadline: REGISTRATION IS NOW CLOSED

There are no refunds or late registrations after October 18.

Cancellations prior to October 18 will be refunded less the processing fee of $15.

Those who miss the deadline can put their name on a waiting list and if a spot opens up, we will notify you.
NOTE: By completing this form you are adding your name to a waiting list.

You are NOT registered for this conference until the registration team contacts you about substituting for a cancellation.
Are you registering a youth to participate or yourself to serve?*

Youth to participateMyself to serve
Participant's name
Today's date

MonthDayYear
Date

Youth Registration
Parent/Guardian name*

First NameLast Name
Best phone number at which to contact you (the parent/guardian)*
Please enter a valid phone number.
Best email at which to contact you (the parent/guardian)*
example@example.com
Registrants' name*

First NameLast Name
Registrant's gender*

MaleFemale
Registrant's locality*
Registrant's grade in school*
Registrant's birthday*

MonthDayYear
Date
Emergency contact name*

First NameLast Name
Emergency contact phone number*
Please enter a valid phone number.
Emergency contact relationship with registrant*
Health insurance and Medical information
Click here if no health insurance information available.

None available
Insurance company*
Insurance policy or group #*
Physician's name*
Physician's phone number*
Please enter a valid phone number.
Child allergies, medications, and other health concerns

Youth Consecration Agreement

Must be read and signed by the young person being registered
In order to uphold an atmosphere conducive to the Lord’s work and speaking and to uphold the standard of the Lord’s life, we ask all participants to consider, pray over, and agree to the following points. Every participant should indicate they have done so by applying their own signature below.
1. I give myself to the Lord to exercise my spirit and to enjoy the word of God!
2. I agree to accept all rules, requirements and arrangements of the YP conference.
3. I commit to punctually attend all meetings and to participate in all activities.
4. I will follow these dress guidelines and I agree to be corrected in the specifics of my attire:
  - Brothers: Long- or short-sleeved shirt with long pants
  - Sisters: Top with sleeves and proper neckline; long pants (no leggings), capri pants, or knee-length skirt.
  - Recreation: Shorts permitted, t-shirts
  - No tank-tops at any time, except to wear to bed
5. I understand that if my conduct undermines the YP conference or distracts others, I will be sent home.
6. I agree to not use my cell phone during the YP conference. I understand specific exceptions to this policy can only be made through fellowship with the conference overseers.
Date*

MonthDayYear
Date
Signature*

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Youth Waivers and Releases
Medical Release and Liability Waiver
I, the parent or guardian of the above-named child (“participant”), hereby release, forever discharge, and agree to hold harmless The Churches in Atlanta, Athens, Kennesaw, Knoxville, Nashville, Memphis, and Birmingham; their staff; and volunteers (collectively, “Indemnitees”) from any liability, claims, or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while that participant is participating in the above described activity.

Furthermore, I assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in transportation, recreation, and activities involved therein.

The undersigned further hereby agrees to hold harmless and indemnify the Indemnitees, their representatives, directors, employees, and agents, for any liability sustained by the Indemnitees as the result of the negligent, willful, or intentional acts of the participant, including any expenses incurred.

I further grant my permission for my child to participate fully in the above-described activity and hereby authorize the bearer of this document to obtain and direct any and all necessary first aid for my child, and, if my child needs emergency medical care beyond first aid, to obtain necessary medical assistance, including transportation, administration of medicines, surgical treatment, X-ray examination, or hospitalization as might be ordered by a licensed medical doctor. By signature hereto I hereby release and hold harmless the Indemnitees of any and all liability with respect to any medical care, medical decisions, treatment, or matters that may arise. I also accept full responsibility for the payment of any expenses incurred from such medical and/or emergency care.
Date*

MonthDayYear
Date
Signature*

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Photo Release
I understand that from time to time activities during the YP conference may be photographed or recorded. The Churches in Atlanta, Athens, Kennesaw, Knoxville, Nashville, Memphis, and Birmingham will never publish a child’s name or any other personal information with any of its publications.
Do you give permission to the aforementioned churches to use any photographs and/or videos of my child taken while participating in activities of the YP conference in the churches' digital and print communications (“publications”).*
Date*

MonthDayYear
Date
Signature*

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Adult Staff Registration
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Gender*

MaleFemale
Locality*
Emergency contact name*

First NameLast Name
Emergency contact phone number*
Please enter a valid phone number.
Emergency contact relationship with registrant*

Adult Waivers and Releases
Liability Release
I do hereby release, forever discharge, and agree to hold harmless The Churches in Atlanta, Athens, Kennesaw, Knoxville, Nashville, Memphis, and Birmingham; their staff; and volunteers (collectively, “Indemnitees”) from any liability, claims, or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while that participant is participating in the above described activity.

Furthermore, I assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in transportation, recreation, and activities involved therein.

The undersigned further hereby agrees to hold harmless and indemnify the Indemnitees, their representatives, directors, employees, and agents, for any liability sustained by the Indemnitees as the result of the negligent, willful, or intentional acts of the participant, including any expenses incurred.
Date*

MonthDayYear
Date
Signature*

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Photo Waiver
I understand that from time to time activities during the YP conference may be photographed or recorded. The Churches in Atlanta, Athens, Kennesaw, Knoxville, Nashville, Memphis, and Birmingham will never publish your name or any other personal information with any of its publications.
Do you give permission to aforementioned churches to use any photographs and/or videos of you while participating in activities of the YP Conference in the churches' digital and print communications (“publications”).*
Date*

MonthDayYear
Date
Signature*

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Fort Mountain Retreat Center Release of Liability
In consideration of the services of Global Youth Ministry, and Alpine Towers International, Inc, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as GYM/ATI), I hereby agree to release, indemnify, and discharge GYM/ATI, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:
1. I acknowledge that my participation in ropes course, blob, hiking, paintball, and other outdoor activities entails known and unanticipated risks, which could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. GYM/ATI programs are based on the “challenge by choice” principle. At any time you and/or your group are free to withdraw from participation in any outdoor activities. The risks include, among other things, the potential for: slips, falls and falling, rope burns, pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards. During and activity there may be contact with plants, animals, or insects that could create hazards such as stings, allergies, and associated diseases. Furthermore, GYM/ATI instructors have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant’s fitness or abilities, they might misjudge the weather.
2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless GYM/ATI from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of GYM/ATI equipment or facilities, including any such claims which allege negligent acts or omissions of GYM/ATI.
4. Should GYM/ATI or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have.
6. In the event that I file a lawsuit against GYM/ATI, I agree to do so solely in the state of Georgia, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against GYM/ATI on the basis of any claim from which I have released them herein.

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Date*

MonthDayYear
Date
Signature*

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2024 Fall YP Conference WAITING LIST

Youth Registration

Health insurance and Medical information

Youth Consecration Agreement

Youth Waivers and Releases

Medical Release and Liability Waiver

Photo Release

Adult Staff Registration

Adult Waivers and Releases

Liability Release

Photo Waiver

Fort Mountain Retreat Center Release of Liability