• 2026 Youth Conference

    Register for camp

  • Date

     Friday 7/17- Saturday 7/18

     

    Location

     Midland Stake Center

     

     

    Registration Process

    Complete this form, inlcuding a clear picture of your child's face. This will not be published. It is only used to help us recognize your child at youth conference.

    Once complete, you will receive a confirmation email. It will contain a link to edit the submission. If you need to make any changes, use this link.

    If you need to cancel your registation, please contact Grant (see contact below).

     

    Contacts

    Registration Questions: contact Grant Rogers at grantarogers@gmail.com

  • Registration

  • Are you registering a youth? If you are an adult registering to attend the activity select 'No'*

  • Participant Information

  • Date of birth*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Does the participant require a special diet?*
  • Does the participant have any allergies?*
  • Can the participant self-administer his or her medication?*
  • Does the participant have a chronic or recurring illness?*
  • Has the participant had surgery or a serious illness in the past year?*
  • Photo of Participant*

  • Contact Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Permission

  • I give permission for my child or youth to participate in the event and activities listed above (unless noted) and authorize the adult leaders supervising this event to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this event and travel to and from this event.

    Please note: Units may not have the ability to meet all medical, physical, and other accommodations and are asked to counsel with parents or guardians on what is possible.

    The participant is responsible for his or her own conduct and is aware of and agrees to abide by Church standards, camp or event safety rules, and other pertinent instructions. The participant’s conduct and interactions should abide by Church standards and exemplify Christlike behavior.

    Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoked if participants behave inappropriately or if they pose a risk to themselves or others.

    This information is collected to help event and activity leaders or medical personnel so they can be prepared and appropriately respond to health concerns or an emergency. It will be kept confidential and shared only as needed.

  • Participant Release (Release to Use Name, Image, Voice, Likeness, and Performance)

  • I, the undersigned, irreversibly grant to Intellectual Reserve, Inc., its related entities, and their respective employees, agents, and representatives (collectively called “IRI”), the full right to create and obtain, in the past, present, and in the future, images, photographs, video, audio, interviews, stories, personal histories, performances (vocal, instrumental, dramatic, or otherwise), mixes, and any other recordings, documents, or materials, in any now known or future media, of my name, image, voice, likeness, performance, and other items (collectively called “Recordings” I also authorize IRI to copyright, adapt, edit, translate, summarize, reproduce, perform, display, distribute, publish, license, sublicense, sell, broadcast, post or stream over the Internet, and otherwise use and allow others to use any and all parts of the Recordings, forever and throughout the world, in any and all manners, and in any and all forms of media that IRI believes suitable. I agree that I shall have no right, title, or interest in or to the Recordings (or to any work comprising or based on the Recordings, in whole or in part), and that all right, title, and interest in and to the Recordings belongs to IRI. I waive any and all right to payment or other compensation arising from or related to the Recordings. I will not state or imply, or allow others to state or imply, that IRI approves of or endorses me or my activities. I further agree to release, defend, and hold IRI harmless from any claims, damages, or liabilities related to the Recordings or IRI’s use thereof. I understand this Release is governed by the laws of the State of Utah, U.S.A.

    By signing below, I represent that I have read this Release, understand its contents, and agree to this Release.

    Name Signature Name Signature Name Signature Name Signature Name Signature

    Address Telephone Address Telephone Address Telephone Address Telephone Address Telephone

    Parent/Guardian Consent (If anyone listed above is a minor, that person’s parent/guardian must sign below

    I, the undersigned, hereby warrant and represent that I am the parent or legal guardian of the minor child named above and printed next to my name below (the “Youth”), that I have full authority to execute this Release on behalf of the Youth, that I have read this Release, and that by signing below I have granted this Release on behalf of the Youth. I hereby agree that I, the Youth, and all other parents or legal guardians, if any, will be bound by all releases, consents, and covenants contained in this Release. I further agree to indemnify and defend IRI against any and all liabilities relating to the Youth’s actions in connection with the Recordings or IRI’s use thereof. NameYouth’s NameDate SignatureYour Telephone NameYouth’s NameDate SignatureYour Telephone NameYouth’s NameDate SignatureYour Telephone NameYouth’s NameDate SignatureYour Telephone NameYouth’s NameDate SignatureYour Telephone

  • Opt-Out of release to Use Name, Image, Voice, Likeness, and Performance*
  • Format: (000) 000-0000.
  •  
  • Should be Empty: