LCMC Great Lakes
24 Hours of Praise, Worship and Fellowship
August 4-5 Noon to Noon
Grades 6-12
St. John’s Lutheran Church
8805 Austin Road Bridgewater, MI 48115
$20 includes food and t-shirt
Youth Registration Form
All blanks MUST be filled out! ALL FORMS MUST BE COMPLETE AND RETURNED
Please Print
Participant Information
Full Name: ______Age: ______Birth date______
Church: ______
Grade in School ______
Address: ______
City: ______State: ______Zip Code: ______
Phone Number: ( ) ______Mobile Number: ( ) ______
Email: ______
T-Shirt Size ______SM, MD, LG, XL, XXL (circle one)
Parent/Guardian Information
Full Name: ______
Address: ______
City: ______State: ______Zip Code: ______
Phone Number: ( ) ______Mobile Number: ( ) ______
Is Parent Attending Conference: ______Yes ______No
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Youth Event Fees: $20 includes t-shirt and food
Important Information:
J Bring an overnight bag and sleeping bag
J Bring a Tent(s) if you need other sleeping arrangements please contact event coordinator Jack Coffey 734-216-0189 or
J Bible
J Registration forms due by 8-1-17 can bring with you on the 4th if you confirm attendance prior with event coordinator.
YOUTH EVENT EMERGENCY FORM
(To be filled out by all Event Attendees)
Participant Name: ______
Name of Parent(s)/Guardian(s): ______
Phone Number: ______Mobile Number: ______
Physician: ______Phone Number: ______
Insurance Company: ______Policy Holder: ______
Policy Number: ______Allergies: ______
Health Conditions: ______
Allergies if none write none:______
______
Please List all medications you are taking and the reason and how often taken:
______
______
______
______
Please list two people, other than parents, that we can contact in an emergency who can legally provide authorization for medical treatment.
Name: ______Phone: ______
Name: ______Phone: ______
Please check one of the following and sign:
______I Request Medical Treatment for my child without prior notification
______I Request NO Medical Treatment for my child without prior notification.
In the event of an emergency, I understand that St. John’s Lutheran Church, Bridgewater MI staff will try to contact me. If I am unable to be reached, St. John’s Lutheran Church, Bridgewater MI will do their best to ensure the safety and health of my child, ______(Insert child’s name).
I do not hold St. John’s Lutheran Church, Bridgewater MI liable in the event of an emergency.
Signature of Parent/Guardian: ______Date: ______
Conference Rules:
All rules apply equally to youth and adults. St. John’s Lutheran Church Bridgewater MI for liability reasons and event safety formed all rules. Enforcement of the event rules is the responsibility of EVERY person attending with overall supervision by the staff on duty. Adults and youth leaders are expected to serve as good role models and to have a signed code of ethics when they check in at conferences.
Attendees will remain on site at all times.
At least 1 adult per 10 youth from each church must be present
being outside designated areas at any time is prohibited.
Illegal use of alcoholic beverages, illegal drugs and weapons are prohibited.
Everyone must attend all mandatory planned activities..
At least two adults will be assigned to each sleeping area.
Smoking is prohibited for adults and youth attending the event
Vehicles are off limits during conferences except for official conference business.
Obey all site rules.
Recommendation that each church writes their own covenant that each participant signs prior to attending the event.
***I have read and will uphold the rules stated. If I do not follow these rules, I may be expelled from the conference.
Signature: ______Date: ______
Chaperone Attending From Your Church: ______
Full Name: ______
Address: ______
City: ______State: ______Zip Code: ______
Phone Number: ( ) ______Mobile Number: ( ) ______
Email: ______
T-Shirt Size ______SM, MD, LG, XL, XXL (circle one)
Church/Organization Name: ______