YOUTH REGISTRATION register << Click HERE for a printable PDF version of this form >> Youth Medical Release & Code of Conduct Form Event:*Youth Retreat 2020 - Thaw Out - March 13-15, 2020Participant's Name* First Last Parent/Guardian Name* First Last Parent Phone Number*Grade in school*choose grade6789101112Volunteer / AdultHome Church (if any)*Code Of Conduct: 1. I will not smoke, drink alcoholic beverages, or use illegal substances, nor will I have in my possession any of the same during this activity. 2. I will cooperate with the scheduled program of activities. 3. I will show respect to myself and others at all time. 4. I will not engage in any inappropriate public display of affection. 5. I will not engage in any sexual activities. 6. I understand that if I do not adhere to this code of conduct, it may result in a warning, calling home, and or expulsion from the event. I understand this means my parent/guardian will be called and they will be required to provide transportation home for me from the event at that time.Consent:* I, the participant, have read and agree to the Code of Conduct.Emergency Contact #1 Name* First Last Emergency Contact #1 Phone*Emergency Contact #1 Relationship*Emergency Contact #2 Name* First Last Emergency Contact #2 Phone*Emergency Contact #2 Relationship*Please explain any restrictions or limitations affecting participation in the activity (be specific)Any known allergies? If yes, please list and be specific*Are any medications required? If yes, please explain*Health Insurance Company*Health Insurance Policy #*AUTHORIZATION: Permission is granted for treatment of minor injury or illness. In the event of an emergency and I cannot be reached, I hereby give permission for the adult(s) in charge to seek professional medical help and transport my child. I have ALSO read the above information regarding the code of conduct and I understand if my child is expelled from the event that I am required to provide transportation home at that time.Parent/guardian: Please type in your name and date as authorization:*