Youth Registration FormYouth Week Registration Form Sign up to attend Youth Week 2016. July 18 - 22nd. Monday - Thursday - 6:30 PM to 9:30 PM Friday - 10 AM to 6 PM (meet at Midway UMC for trip to Lake Lanier Water Park.)Parent's Full Name*Parent's Cell Phone Number*Parent's Email*Emergency Contact Name*Emergency Contact Phone Number*Full Name of Youth*Parental Release Information*Medical Release: By clicking the checkbox below, I affirm that in the event of an emergency involving my child, and Midway United Methodist church representatives cannot get in touch with me, I hereby authorize any needed emergency medical care. I further agree to be fully responsible for any and all medical expenses incurred during the treatment of my child. Medical ReleasePhotographic Release*By checking the checkbox below, I give permission for representatives of Midway United Methodist Church to photograph my child. I understand that these pictures will be used only for purposed designated by Midway United Methodist Church. Photographic ReleaseLiability Release*As consideration for being permitted by Midway United Methodist Church, to participate in Youth Week 2016 and use Midway UMC premises and facilities, I forever release Midway United Methodist Church, their staff, volunteers and members (collectively "releases') from any and all actions, claims, or demands that I, my assignees, heirs, distributes, guardians, next of kin, spouse and legal representatives now have, or may have in the future for injury, death, or property damage related to (I) my minor child's participation in Youth Week 2016, (ii) the negligence or other acts, whether directly connected to this activity or not, and however caused, by any Releasee, or (iii)the condition of the premises where this activity occurs, whether or not my child is then participating in the activity. I also agree that I, my assignees, heirs, distributes, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release. BY CLICKING SUBMIT BELOW, I AFFIRM THAT I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS, I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF on behalf of MY MINOR CHILD, AND MIDWAY UMC, AND ACKNOWLEDGE IT OF MY OWN FREE WILL ON BEHALF OF MY MINOR CHILD. Liability ReleaseRegistration Fee* Price: $55.00 Registration Fee includes Lake Lanier Water Park on Friday, July 22.EmailThis field is for validation purposes and should be left unchanged.