Peace Starts With Me: Las Vegas - 7-Day Leadership Workshop

Peace Starts With Me: Las Vegas - 7-Day Revival

Your Information

Please select your pay rate (no pre-approval/application required):*

Full ownership ($700.00)
Partial HQ subsidy ($500.00)
Full HQ subsidy ($350.00)

Name*

Gender*

Male
Female

Date of Birth*

Email*

Confirm Email*

Cell Phone*

Emergency Contact Information

Mailing Address*

Sub Region*

Local Church community*

Current Occupation*

Dietary Restrictions

Vegetarian
Vegan
Gluten free
Lactose Intolerant
Allergies

Medical Information

Health Insurance*

I do not have health insurance
I do have health insurance

Lodging*

I am coming from out of town and would like to reserve lodging at IPEC for the entire 6 nights
I am local and will be commuting to IPEC each day (as I understand lodging is limited)

Transportation*

I will be driving myself to IPEC
I will be flying in and out of the Las Vegas airport (LAS) and need a shuttle pickup on Wednesday, June 19 and drop off on Tuesday, June 25.

T-Shirt Size (Men's)*

Did you just graduate from high school? If so, would you like to participate in a special Grad Night Dinner on Friday evening with 2019 grads from around the country? (Free!)

Grad Night Dinner*

Yes please!
No, thanks

The 7-Day participants will be joined by the 3-Day Revival participants from Friday to Sunday. In what ways would you be interested in supporting the weekend activities:

Weekend Activities*

Rally Support Day-Of
Weekend Revival Team Leader (for high school or young adults)
Weekend Revival miscellaneous support

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 7-day program on June 19-25, 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.

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Coupon Code

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$0.00

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