UNITE Registration & Medical Release

Unite Youth Conference 2021 Participation Agreement 

ACTIVITY INFORMATION 

Name of Sponsoring Organization: First Brethren Church of North Manchester
Address: 407 N Sycamore St, North Manchester, IN 46962 Phone: (260) 982-6457 
Description of Activity: North Manchester First Brethren Church is hosting their 2nd youth conference for grades 7-12. This event will be completely free and filled with speakers, awesome worship, games, & food.  
Date(s) Friday, August 6 (6:30-10 pm); Saturday, August 7 (9:30 am – 9:30 pm)
Location of Activity: North Manchester First Brethren Church, 407 N Sycamore St, North Manchester, IN 46962

PARTICIPANT INFORMATION (TO BE COMPLETED BY PARTICIPANT OR AUTHORIZED GUARDIAN)

    Is the Sponsor authorized to approve medical treatment?

    Is the participant covered by personal/family medical insurance?

    PARTICIPATION AGREEMENT I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.