March 9-11, 2018

Ocean City Convention Center

We’re staying at

Quality Inn Boardwalk

Boardwalk and 17th Street

1601 Atlantic Ave-

nue • Ocean City,

Maryland

410-289-4401

800-837-3584

Cost for Transportation,

Lodging and Conference

Registration: Prior to Feb 14th $175

Normal Registration: after Mar 1st $199

YOUTH FOR CHRIST/USA, INC. – PARENTAL CONSENT AND RELEASE OF LIABILITY

1. RELEASE OF LIABILITY

I understand that the opportunity to attend YOUTH FOR CHRIST/USA, INC. activities is a privilege. In consideration for that privilege, I am signing this Release of

Liability form on behalf of myself and my minor children I understand that my child may participate in any number of physical activities some of which include, but are

not limited to, recreational activities and games. I understand that there are certain risks of physical injury or illness associated with these activities. In addition, I under-

stand that there may be other risks associated with these activities of which I may not be presently aware. By signing this Release, I expressly assume these risks for

my child and me, whether such risks are known or unknown to me at this time. I release YOUTH FOR CHRIST/USA, INC., including its affiliated chapters and their

officers, directors, volunteers, employees, contractors and agents, from any claim that I or my children may have now or in the future against them for any physical and

personal injury, illness or death due to participation in YOUTH FOR CHRIST/USA, INC. activities. This release of liability shall cover (without limitation) all claims for

negligence and breach of fiduciary duty asserted by my child or any person made on their behalf.

2. AUTHORIZATION FOR MEDICAL TREATMENT

With the increasing sophistication of the medical system, I understand it may be necessary to have a parental consent form present in the unlikely event of an injury or

condition requiring medical treatment of my child. This consent and release gives YOUTH FOR CHRIST/USA, INC. and its personnel the permission to take my child to

the nearest, available medical facility and have any necessary emergency treatment administered. In case of emergency, I understand that efforts will be made to

contact me, however if I cannot be reached, I hereby give Youth for Christ/USA Inc. and its representatives the permission to act on my behalf in seeking emergency

medical treatment for my child in the event that such treatment is deemed necessary or advisable for my child’s health, safety and welfare. I give permission to those

administering medical treatment to do so, using the measures deemed necessary. I release Youth for Christ/USA Inc., its representatives, and all medical providers

from liability in acting in this regard and rendering such medical treatment. I will be fully responsible for all such medical expenses.

I represent that I am the parent/guardian of the child named below, who is under 18 years of age. In consideration for allowing my child/ward to participate in YOUTH

FOR CHRIST/USA, INC. activities, I hereby consent to the foregoing on behalf of my child/ward and agree that this release shall be binding upon me, my child/ward,

and our heirs, legal representatives and assigns. I hereby agree to defend, indemnify and hold YOUTH FOR CHRIST/USA, INC., including its chapter affiliates, their

directors, volunteers, employees, contractors and agents, harmless from any liability asserted by my child/ward subsequent to his or her reaching majority, including

reasonable attorney's fees and costs. I also warrant that my child/ward is physically fit and able to participate in all activities.

3. MEDIA RELEASE

I grant permission to YOUTH FOR CHRIST/USA, INC. the right to use, reproduce, and/or distribute any photographs, film, video and sound recordings of me and my

child, without compensation or approval rights, for use in materials created for purposes of promoting the future activities of YOUTH FOR CHRIST/USA, INC.

4. BEHAVIORAL AGREEMENT

I understand that illegal or forbidden activities or behavioral issues may result in the named participant being sent home at the expense of the parent(s)/guardian(s).

(These activities would include but not be limited to the possessions and/or use of drugs, alcohol or weapons; sex outside of the marriage relationship; stealing;

fighting; etc.) YOUTH FOR CHRIST/USA, INC. will make efforts to contact the parent(s)/guardian(s) to make arrangements before the named participant is sent home.

MEDICATION INFORMATION

Any medication brought to Impact must be accompanied by written instructions from a physician/parent. All prescriptions must be brought to Impact in the original

container in which they were issued (with medical instructions, dosage information, etc.).

Agreement with the above: Both Student and Parent must acknowledge and agree.

Address:

City State Zip Student’s Phone

Student’s Signature _________________________________________________________Date _________

Parent’s Phone

Parent or Legal Guardian Signature____________________________________________ Date ____________

Student Medical History:

List Student’s known Medical/Physical Restrictions/Conditions or Limitations:

List Student’s allergies, including medication allergies or reactions:

List any medications taken or necessary:

Please add details to any questions asked: use additional pages if needed.

Physician & Insurance information

Physician’s Name/Practice:

Physician’s Phone:

Insurance Company Name:

Insurance Phone #

Policy #

Group #

Other Information Needed:

Student’s full name:

Painting Freedom Art Production

Society is visually driven and individ-uals are hardwired to remember and respond to pictures. Yet our culture inundates people with imagery that feeds into dark-ness. Painting Freedom is fighting against that by bringing light and hope into the darkness. Painting Freedom provides inno-vative, compelling, visual depictions of the gospel by utilizing and combining a variety of art forms. A multisensory experi-ence--visual, audible, and personal, leaves those who experi-ence our performances with an enduring impression. Painting Freedom utilizes Speakers, Live Performance Artists, Spoken Word artists, and Musicians and worship teams.

K J - 5 2 Speaker & Music

Bean & Bailey, Comedy

True to the precedent he set very early in his career, KJ presents spiritual truth with clever rhymes, from a unique perspective. Only this time he does it with a vulnerability previously unheard. And at the core is one central message: a higher power will go be-

fore you, through all stages of life, through every up and down, if you are willing to believe.

We believe that Humor is a gift from God that brings people together. Laughter tightens bonds, helps rebuild relationships, and it breaks down

barriers so that we can listen

Music by D.J. Morph For over a decade, DJ Morph has remained a staple in the EDM/Hip Hop genre, commonly regarded as one of the premier DJ’s/producers of our market. With five nationally distributed al-bums, a Dove award nomination, Movie sound-track placements, extensive travels both nation-ally and internationally with artists such as KJ-52, Trip Lee, Funky, Hawk Nelson, Derek Minor, Propaganda and many more, DJ Morph has shown no signs of slowing down.

THE REMEDY [WORSHIP] is a collective of musicians whose passion is sharing the love of Christ and responding to

his grace in true and authentic worship. They aim to elevate the name of Jesus by loving

people well through authentic relationships and playing music with excellence in any

setting

Bob Lenz, Speaker

Bob Lenz has a humorous, down-to-earth style combined with genuine concern. A storyteller at heart, Bob

combines his personal experience with in-depth biblical knowledge, awaken-

ing understanding and inspiring others to embrace faith in Christ and make the next step closer to God. He cap-

tures the audience’s attention immedi-ately and sensitively spans denomina-

tional walls

Painting Freedom is a collective of artists dedicated to the rapid

spread of the Gospel through the arts.

Your registration includes: Conference registration,

Hotel: 2 nights (shared room) , bus transportation and pizza

on Saturday night. You will need money for food and anything

you decide to purchase. For more information please talk to

your YFC, Deaf Teen Quest or Campus Life Leader or you may

call Arn Bjorndal (Executive Director) at 301-663-0561.

You may call for any information or discussion on the trip.

Make check payable to Youth for Christ

Return it to your YFC, Campus Life or Deaf Teen Quest Leader

or send it to P.O. Box 3944 Frederick, Maryland 21705

Check us out on the web at www.yfccm.org