Peace Starts With Me: Youth Revival on Friday + Saturday

Registration for Peace Starts With Me: Youth Revival

Friday & Saturday Program in Los Angeles

April 5 and 6, 2019

Los Angeles Family Church +
City of Refuge Church, Gardena, CA

The two-day registration fee is $30.

This price includes:

Friday Dinner: Pizza
Saturday Breakfast: Panera baked goods
Saturday Lunch: Sandwiches
Saturday Dinner: TBA

*Unfortunately, due to the sheer size of this program, we are not able to fully accommodate dietary restrictions (vegan, gluten free, etc). If the above menu poses a challenge, we suggest you bring some supplements. We will have a few limited alternative options for Friday and Saturday.

Transportation

“I understand that this registration DOES NOT include transportation for the entirety of the weekend.*

Your Information

I am registering:*

For the Friday evening program at the L.A. Church AND the Peace Starts With Me: Youth Revival at City of Refuge ($30.00)

Name*

Gender*

Male
Female

Date of Birth*

Email*

Confirm Email*

Cell Phone*

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Emergency Contact Information

Sub Region*

City*

State*

Local Church community*

Current Occupation*

Dietary Restrictions*

None
Dairy free
Vegetarian
Vegan
Gluten free
Other

Lodging at the L.A. Church

Please indicate the nights you would like to stay at the L. A Church:

Friday night (April 5)*

Saturday night (April 6)*

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 2-day program on April 5 and 6, 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.

Coupon Code

Total

$30.00

Billing Information

Name*

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

Email*

Confirm Email*

Phone Number*

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.