Individual Registration Slip

iServe 2010 Registration Form iServe Philadelphia ’10

Being God’s hands to a city God loves.

www.northatlanticyf.wordpress.com

2.26-28.10

Name: ____________________________________ Please circle if you are a: guy / girl Address: __________________________________ Phone number: _____________________________ E-mail address: _____________________________

If you register before the Feb. 7th deadline, you will be entered in the drawing to win a prize!

Grade: ______ School: _______________________ Church name: ______________________________ Any medicine you must take during the weekend: __________________________________________

An iServe T-Shirt is included in this year’s price! Please select the appropriate size. Then give your Youth Pastor this form and your $30 registration cost before 2/7/09! S ___ M ___ L ___ XL ___ XXL ___ (T-Shirts are adult sizes)

Flip over and have your parent complete the iServe Permission Form

iServe 2010 Permission Form www.northatlanticyf.wordpress.com

2.26-28.10

iServe Philadelphia ’10

Being God’s hands to a city God loves.

I understand that the N.A.Y.F. does not carry medical insurance. Here is my student’s insurance information. ______________________________ ______________________________ (Insurance Co. and policy #) If HMO, include primary care info, if necessary: Doctor: _______________________ Phone # _______________________

I (we) ____________________________ knowingly allow our student ____________________________, to attend the North Atlantic Youth Conference in Philadelphia, PA on Friday, February 26th-Sunday February 28th. I understand that the group will be spending time at different Grace Brethren Church locations, including Urban Hope Training Center. A majority of our time on Saturday will be used to serve the people and the churches of Philadelphia, including using service projects. I also understand that the leadership of the N.A.Y.F. and the youth pastors and youth sponsors of these churches and the employees of the host churches and Urban hope Training Center will do everything in their power to assure the safety and the well-being of my student during the event. In the event of a minor injury, I give permission for the leadership to give basic medical treatment. Initial: ____ In the event of a major injury, I give permission for professional medical treatment, which may include an ambulance ride to the nearest medical facility. Initial: ____ As my student’s legal guardian, I understand the inherent risks of all activities, including this one. 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, The North Atlantic Youth Fellowship.

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. If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association. If my student continually disregards our guidelines, it will be my responsibility, at my expense, to pick my student up at the event. _______________________________ _________ (Signature of Participant)

(Date)

_______________________________

_________

(Signature of legal guardian)

(Date)

Name of emergency contact: ___________________________________________________________________________________ Telephone (Day): _____________________________________ Telephone (evening): _____________________________________ List allergies or medical conditions: ______________________________________________________________________________

Flip over and have your student complete the iServe Registration Form