WWNF Youth Registration Web Site Thank you for registering! WWNF - Youth SPRINGFIELD - Women Walking N Freedom Youth - Turning Point Church select WWNF-Youth location Youth First Name * Youth M.I * Youth Last Name * Youth Address * Youth City * Youth State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Youth Zip Code * Youth Cell Phone * Youth Email * Youth Age * Youth Grade * 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Youth Food Allergies * Parent First Name * Parent MI * Parent Last Name * Parent Address * Parent City * Parent State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Parent Zip Code * Parent Cell Phone * Parent Email * Emergency Contacts Emergency Contact Name 1 * Emergency Contact 1 Cell Phone * Emergency Contact 1 Relationship * Emergency Contact Name 2 * Emergency Contact 2 Cell Phone * Emergency Contact 2 Relationship * Parental Consent & Liability - The undersigned does hereby give permission for registered child/youth to attend and participate in this House of Refuge Ministries, Inc event/workshop. LIABILITY RELEASE: In consideration of House of Refuge Ministries, Inc. allowing the Participant (registered child/youth) to participate in this event, I, the undersigned, do hereby release, forever discharge and agree to hold harmless House of Refuge Ministries, Inc., its pastors, directors, employees, volunteers and teachers from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant (registered child/youth) while involved in the children/youth event activities. I the parent or legal guardian of this Participant (registered child/youth) hereby grant my permission for the Participant (registered child/youth) to participate fully in event activities. Furthermore, I, on behalf of my minor Participant (registered child/youth) , hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify House of Refuge Ministries, Inc. for any liability sustained by said House of Refuge Ministries, Inc. as the result of the negligent, willful or intentional acts of said Participant (registered child/youth) , including expenses incurred attendant thereto. MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization. EARLY RETURN HOME POLICY: Should it be necessary for my child or youth to return home due to medical reasons, disciplinary action or otherwise, the undersigned shall assume all transportation costs and responsibility. Parental Consent & Liability Agreement I have read and agree to the Parental Consent & Liability Agreement * Parent or Legal Guardian Electronic Signature * legal first name, MI, last name Newsletter * Yes No Join Our eCommunity! Yes, sign me up to receive eNewsletter and updates on how the House of Refuge Ministries, Inc is sharing the love of Jesus Christ to families broken by abuse!
