REGISTRATION INFO:Complete the form below and return it with a $50 deposit to your Campus Life Director.

Name: _________________________________

School: _________________________________

Grade: _________ Shirt Size: S M L XL XXL

Address: ________________________________

City: ______________ St: ______ Zip: ________

Phone: _________________________________

Emergency Phone: ________________________

Parent/Guardian Name:_______________________________________

Parent/Guardian Email:_______________________________________

Pre-existing Conditions/Medical Issues/Allergies:

_______________________________________

_______________________________________

Insurance Company: _______________________

Policy #: ________________________________

Name of Policy Holder: ____________________

The fun begins when you step on to the luxurious EXCURSIONS CHARTER BUS that will get us where we need to be. We will board the buses at the Youth For Christ offices (6427 Oakbrook Parkway) at 7:00 am on Sunday, March 29 and return on Wednesday, April 1 at 9:00 pm.

We will be staying in the lodges at CAMP BA YO CA in Sevierville, TN just outside of Gatlinburg. This will be base camp for all our activities. You will have opportunities to hike, play big group and small group games, relax with your friends, and much more! We will also travel off campus for some fun in town in Gatlinburg.

Your cost of just $150 covers lodging, transportation, all group activities throughout the week, and most meals. Students will need extra money for two meals on the roadlunch on Sunday and dinner on Wednesday. We advise sending money in an envelope labeled for Wednesdays dinner to make sure students save enough money to eat at the end of the trip. DEPOSITS should be made when you register and are due no later than MARCH 3. FINAL PAYMENTS are due by MARCH 17.

CAMPUS LIFE | SPRING BREAKJoin us for all the CAMPUS LIFE fun you can handle this spring break as we travel to the mountains in GATLINBURG, TN for an incredible week away! Check out all the details, ask your parents,

and get registered now!

Complete the attached registration form and turn it in with a $50 DEPOSIT to your CAMPUS LIFE director. We cant hold your spot without the deposit.READY TO GO?

Contact our office:260.484.4551 QUESTIONS?

SPRING BREAKCAMPUS LIFE

As parent/legal guardian of this student, I have reviewed the information about this event and give my permission for the subject of this release to be involved in the overall activities connected with the event.

I have reviewed the rules of the activity and agree that the subject of this release will abide by them.

I consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of the subject of this release during the activity/event to be used, distributed, or shown as Youth For Christ determines.

I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I can not be reached, in an emergency, during the activity dates shown on this form, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary.

I understand all reasonable safety precautions will be taken at all times by Youth For Christ and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Youth For Christ, its leaders, its employees, and/or volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.

_______________________________________ Parent/Guardian Signature Date

_______________________________________ Emergency Contact #

MEDICAL/LIABILITY RELEASE FORM CAMPUS LIFESPRING BREAK

MAR 29-APR 1$150GATLINBURG

ADDITIONAL MONEY INFO:We will stop for 2 meals en route to and from Gatlinburg (1 meal each way). Students will need spending money for these meals as well as for any gifts, souvenirs, or snacks they plan to purchase.

We will head into downtown Gatlinburg for an afternoon to give students an opportunity to shop.

PACKING INFO:We will be in the mountains and staying in cabins. We will spend time hiking, playing outdoor games, lounging around the cabins, and walking around town. The list below is a guideline for what students may need but use your best judgement as you prepare.

Shower TowelToiletriesSleeping bag or sheetsPillowClothing for the week

*Additional items to pack may be communicated closer to the date of the trip.

NORTHERN INDIANA

6427 Oakbrook Parkway Fort Wayne, IN 46825 260-484-4551 www.yfcnorthernindiana.org