Youth River of Life

River of Life 2025

Youth Registration
Registration

Registration Fee is $120

Deadline is April 30, 2025 No refunds after June 1, 2025

Youth MUST be entering 6th grade or age 11 by June 1, 2025
Full Name*

First NameMiddle NameLast Name
Age*
Entering Grade*
Gender*
T-shirt Size (Youth or Adult)*
Youth Phone Number
Youth Email
Parent Email*
Church*
Phone Number
Youth Pastor*
I understand that the River of Life event leaders will assign me to a work team. Though I am willing to work on any team, I would prefer to be assigned to (check one)

Painting TeamBuilding Team (repairing or constructing porches and/or wheelchair ramps)Yard WorkAssign me where I am needed most
Emergency Contacts
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Medical Information
Is the youth named above covered under hospitalization insurance?*

YesNo
Does youth have insurance card?*

Yes (Please submit a copy with this form)No
Name of insurance company
Policy Number*
If not applied please input N/A
Name of policy holder
Family physician
Physician Phone Number
Please enter a valid phone number.
Please list any allergies to medications, foods, insect stings, etc. Please be specific.
Please list any medications taken routinely including name of medication and dosage.
Are there any other medical conditions that are relevant to the youth's participation in River of Life.*

YesNo
If yes, please explain
I give permission for my child, name* to participate in the River of Life Mission event, June 18 – 22, 2025. I understand my child will be assigned to a work team that will involve painting, roofing, minor construction, or other home repairs/improvements. I give my permission for pictures/video of my child to be published. Transportation is provided to the worksite. If my child drives themselves to the event, I understand that they will be required to turn their keys into Registration upon arrival. If any youth needs to leave for any part of the event for any reason, an Absentee Consent Form is required. No youth will be allowed to leave without this form on file.
In case of emergency, I realize every attempt will be made to contact me. In the event I cannot be reached, I hereby authorize the River of Life counselors to sign for medical treatment for my child. I will not hold River of Life, the participating churches, the directors, or the counselors liable for any injuries incurred by my child.
Signature of Parent/Guardian*

Clear
Date

MonthDayYear
Date
Insurance Card Upload

Cancelof

Absentee Consent Form
The River of Life event is scheduled to take place from 3:00 pm on Wednesday, June 18 through 11:00 am on Sunday, June 22. This schedule allows for a significant amount of work to be accomplished by the work teams. The agenda includes worship and fellowship activities following dinner each evening. It is very important that each participant attend all sessions. If you must be away for any period, this form must be completed and turned in by registration on Wednesday. All youth who drive themselves to the event must turn their keys into Registration on Wednesday. If you are scheduled to leave for any part of the event, you should make sure to request your keys before you leave the church in the morning to go to your worksite.
I, youth namewill be absent from River of Life during the following time(s):
Wednesday, June 18Thursday, June 19Friday, June 20Saturday, June 21Sunday, June 22
From ___ until ___.
To pay registration fees you can either make a payment online through the Dallas First UMC website or mail a check to our church office at 141 E. Memorial Dr Dallas, Ga, 30132
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