BYC Youth Retreat 2022 Registra...

By registering your child for the 2022 NY Metro Region Youth Retreat at Tuscarora Inn & Conference Center, you are acknowledging and accepting the terms outlined below: I acknowledge and accept that participation in this Youth Trip with Bethlehem Assembly of God (the “Church”) involves some risk to the participant and, during the course of such participation, the participant may sustain and/or contract one or more injuries and/or illnesses (or experience worsening of an existing injury or illness). In the case of emergency, whereby my child requires immediate medical attention and I nor any other authorized adult cannot be reached, I give permission to the church coordinators, employees, volunteers, or any other representatives (collectively, the “Church’s Agent”) to perform and/or seek emergency treatment or procedures by a doctor, hospital, or emergency medical team as deemed required for the well-being of my child. I accept personal financial responsibility for any injury, illness and/or other loss sustained during the trip and any medical treatment rendered to my child that is authorized by the Church’s Agents. By allowing my child to participate in this event, I understand that the church will take reasonable steps under the circumstances to provide a safe environment for my child and to ensure that all equipment supplied by the Church for the activity is of reasonable standard. I acknowledge that the Church will not be liable for any injury that may be suffered by my child (or any worsening thereof) which arises either directly or indirectly from, or in connection with, the event and its activities. I hereby agree to indemnify the Church against any and all claims arising from, or in connection with, any injury and/or illness that may be suffered by my child (or any worsening thereof), or that my child may cause to another person, as well as any loss or damage to property, equipment or personal effects belonging to my child, or any other person, arising either directly or indirectly out of or in connection with the event and its activities.

Registration for Youth Retreat 2022

Registration Details

Health & Permission Slip

Emergency Contact Information

If you have medical insurance, your carrier will be billed for medical charges in the event of an illness or injury while your child is under the supervision of Bethlehem Assembly of God and the New York Ministry Network.

If your child should require medical attention for injuries received or illnesses contracted prior to activity, please send us the necessary information to give him/her proper medical care during his/her time with the youth ministry.

Health History Information

I have read the terms & waiver form. I have filled out this form to the best of my knowledge. By filling out my name, I agree to the statements listed throughout this Permission slip.