DYG Registration & Liability Release for Motion '26

Youth Registration

Youth Name

Phone

Address

Release of Liability

I certify that I am the parent/legal guardian of the above-named youth and that I do hereby release from all liability Family Worship Center of Port Orange Inc., for the duration of the trip and any or all adult sponsors and chaperones in the event of an accident during the Motion Conference, Thursday, July 23rd - Saturday, July 25th, 2026. Should emergency medical treatment be needed for my child, I authorize Pastor John, Pastor Cathy, or an appointed chaperone to act on my behalf and approve the appropriate treatment.

Digital Signature

Relationship to youth

Emergency Contact/Medical Information

Please list 2 emergency contacts. Include phone numbers with area code. In the event of emergency we will attempt contact in the order listed on the form.

Allergies - please let us know if your youth has any allergies that we need to be aware of and if so, what the recommended treatment is to resolve them. If none, you can type n/a

Medications - please let us know if your teen is taking any medications, including dose and frequency. If none, you can type n/a

Description

Please fill out this form and click submit.

DYG Registration & Liability Release for Motion '26

Description

Please Fix the Following