Peace Starts With Me: Las Vegas

Peace Starts With Me: Las Vegas - 1-Day Experience

Your Information

I am registering as a:

High School Youth ($40.00)
(attending 9th-12th grade in the Fall)
Young Adult ($40.00)

Name

Gender

Male
Female

Date of Birth

Confirm Email

Cell Phone

Emergency Contact Information

Mailing Address

Region of the US

Current Occupation

Code of Conduct

I will engage and participate fully in the prepared program.
I will adhere to staff instructions and guidance.
I will not engage in any substance related activities (alcohol, recreational drugs, cigarettes, etc) or exclusive romantic relationships.
I will have fun! And help others to have fun!

Print Name (Participant)

Signature (Participant)

I, the undersigned, agree to the terms above.

Waiver

(If you are 18+ you may sign the waiver in your name).

I, Parent/Legal Guardian/Young Adult, do hereby acknowledge that I will release the Holy Spirit Association for the Unification of World Christianity (hereinafter “HSA-UWC”), its officers, directors, staff members, volunteers, advisors, property owners, or agents from any and all claims which may hereafter develop or accrue to them on account of injury, loss or damage, which may be suffered by said child/children or to any property, because of any matter, thing, or condition, negligence or default whatsoever, in connection with the Peace Starts with Me: Youth Revival 1-day program on June 22, 2019.

I hereby assume and accept full risk and danger of any hurt, injury or damage that may occur through or by reason of any matter, thing or condition, negligence or default, or any person or persons whatsoever.

I authorize medical treatment for my child/children/individual in case of accident or illness during or in relation to his/her/their participation in the Peace Starts with Me: Youth Revival and will be responsible for all the expenses and charged incurred thereof.

I have carefully read this Parent/Legal Guardian/Young Adult Waiver Form and fully understand its contents. By signing and/or agreeing to this document, I agree to its terms.

Print Name (Parent/Legal Guardian/Young Adult)

Singature (Parent/Legal Guardian/Young Adult)

I, Parent/Legal Guardian), _______________________________________________, do hereby acknowledge that I will release the Holy Spirit Association for the Unification of World Christianity (hereinafter “HSA-UWC”), its officers, directors, staff members, volunteers, advisors, property owners, or agents from any and all claims which may hereafter develop or accrue to them on account of injury, loss or damage, which may be suffered by said child/children or to any property, because of any matter, thing, or condition, negligence or default whatsoever, in connection with the Peace Starts with Me Workshop on November 10-12, 2018 (“Workshop”). I hereby assume and accept full risk and danger of any hurt, injury or damage that may occur through or by reason of any matter, thing or condition, negligence or default, or any person or persons whatsoever.

I authorize medical treatment for my child/children in case of accident or illness during or in relation to his/her/their participation in the Workshop and will be responsible for all the expenses and charged incurred thereof.

I have carefully read this Parent/Legal Guardian Waiver Form and fully understand its contents. By signing and/or agreeing to this document, I agree to its terms.

I, the undersigned, agree to the terms above.

Social Media

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Coupon Code

Total

$0.00

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Confirm Email

Phone Number

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