Focus VBS 2020 Registration

Rally Youth Conference

To register your child for the Rally Youth Conference, please fill in the form below and click "SUBMIT." This form includes medical and media releases as well as emergency contact information. You can use one form to register up to four siblings.

Dates: July 17th & 18th

Cost: $80

Location:

The Fathers House

4800 Horse Creek Dr, Vacaville

Parent/Guardian Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Format: (000) 000-0000.
E-mail*

Minor Waiver & Transportation Authorization Agreement
Child's Name*

First NameLast Name
2nd Child's Name*

First NameLast Name
3rd Child's Name*

First NameLast Name
4th Child's Name*

First NameLast Name
MINOR WAIVER

I, the parent or guardian of the child(ren) listed above, give permission for my child(ren) to participate in Rally Youth Conference 2025 occuring on July 17-18th, 2025. I fully understand, appreciate, and assume all of the risks associated with my child's attendance. In exchange for my child's participation, I hereby agree to the following:
1. I voluntarily waive, release and hold harmless The Mission, its agents, employees, and other volunteer workers from any and all claims, causes of action and damages for bodily injury, illness, or death that my child may suffer as a result of, or in any manner connected with their participation in this event when such bodily injury or death is the result of their own negligent or intentional acts or omissions. I understand that this waiver and release precludes my right to recovery of damages in the event my child is injured in the course of participating in this event.
2. By signing below, I understand that while participating in this event, The Mission and/or its designee may take photos, video, or audio of the event participants in action. I give unrestricted permission to The Mission and/or its designee to use my child’s image, voice, or likeness in promotional materials or for publicity purposes. I agree that these images and/or voice recordings may be used for a variety of purposes and that these images may be used without further notifying me. I further acknowledge that I will not be compensated for these uses, and that The Mission exclusively owns all rights to the images, videos, and recordings, and to any derivative works created from them.
3. I understand that while my child participates in this event, he or she is responsible to abide by the rules set forth by The Mission and to comply with all orders and directives of supervisory personnel. I agree to accept full responsibility, financially or otherwise, for any damage my child may do to the property of The Mission, properties visited on outing, other’s personal property, or vehicles used for transportation.
4. I understand that an inherent risk of exposure to COVID-19 exists in any public place where people are present. By allowing my child to attend this event, I assume all risks related to exposure to COVID-19 and agree not to hold The Mission, its agents, employees, and other volunteer workers liable for any illness or injury.
I have read, fully understand and agree to the assumption of risk, waiver, release, hold harmless and indemnification terms set forth above.
TRANSPORTATION AUTHORIZATION

I, the parent or guardian of the child(ren) listed above, The Student attends The Mission in Vacaville, a California nonprofit organization (the "Church") In consideration for transportation to be provided to the student by volunteer drivers, including parents of other students and persons employed by the Church (the "Volunteer Drivers"), in their personal vehicles in connection with events and activities organized, sponsored, or conducted by The Mission (the "Transportaion"), I, on behalf of myself, my spouse (if any), and the student and all of our personal representatives, executors, successors, assigns, and related parties, herby agree and reresent as follows:

1.I authorize the Student to be provided with the Transportaion by the Volunteer Drivers. I understand that each Volunteer Driver is certified he/she:(i)holds a valid and unrestricted California Driver's Licebse;(ii)has no medical or other conditions that could impair his or her ability to operate his/her vehicle in a safe manner;(iii)maintains an automobile insurance policy that privides at least minimum coverage required by California law;(iv)when providing the Transportaion will only operate a vehicle that is properly registered, equipped with seat belts and in safe working condition; and (v)will notify the church if any of the foregoing representations change.

2.I understand that The Mission will not independently verify that the certfications made by each Volunteer Driver are correct. As a result, The Mission cannot, and does not, gaurantee that the Volunteer Driver certifactaions are accurate and/or will remain current. I understand that the Volunteer Drivers may or may not be employees of The Mission while providing transportation and The Mission has neither control of, nor responsiblity for, their actions.

3.I, on behalf of myself, my spouse (if any), and the student and all of our personal representatives, executors, successors, assigns, and related parties, hereby release, waive, relinquish, disharge from liability, covenant not to sue, and agree to indemnify, defend and hold harmless, The Mission, and it's employees, volunteers, including the Volunteer Drivers, insurers and others similarly situated (the"Releasees") from any and all injuries (including death) to the Student, and any loss or damage to property owned by me or by the Student, in connection with Transportation including, but not limited to, those arising from any negligent act or omnission by any of the Releasees.

4.I have the authority to enter into this release on behalf of the Student without the approval of any other person or entity, and I HAVE CAREFULLY READ THIS RELEASE, AND FULLY UNDERSTAND ITS CONTENTS.
Parent/Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

Emergency Consent Form
Child's Name*

First NameLast Name
2nd Child's Name*

First NameLast Name
3rd Child's Name*

First NameLast Name
4th Child's Name*

First NameLast Name
If your child needs emergency medical care and you are not available to give formal consent to medical authorities, care may be unnecessarily delayed. To protect your child, please complete this EMERGENCY CONSENT FORM. The form will accompany your child to the hospital.

I, Parent/Legal guardian of the above named child(ren), do hereby give my consent to The Mission, its elected and appointed officials, officers, employees, agents and other volunteers, to secure and authorize such emergency medical treatment as the above named might require while under the supervision of said care provider. I do further agree to the performance of such treatment, anesthetics, and operations as in the opinion of the attending physician that is deemed necessary for said child. I also agree to pay all the costs and fees incurred in connection with such emergency medical care or treatment for this child(ren) as secured or authorized under this consent.

NOTE: Every effort will be made to notify the parent/legal guardian in case of an emergency.
YesYes, except...No
Treatments Not to be Performed:
What action should be taken should your child(ren) require medical attention?*
Preferred Medical Treatment Plan
Parent/Guardian Name*

First NameLast Name
Date

MonthDayYear
Date
Signature*
For each child you are registering, please list medical conditions or allergies Cultivate youth staff should be aware of:
Medical Information:*
Medical Record # for Child 1*
Medical Record # for Child 2*
Medical Record # for Child 3*
Medical Record # for Child 4*
Primary Emergency Contact*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Secondary Emergency Contact*

First NameLast Name
Phone Number*
Format: (000) 000-0000.

Payment

My Products*

Youth - Registration $80.00

# of Children

Enter coupon

Total $0.00

Should be Empty:

Parent/Guardian Information

Registrant (Child) Information

Minor Waiver & Transportation Authorization Agreement

Emergency Consent Form

Payment