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Campus you regularly attend
Please list any dietary restrictions and/or food allergies
Please list any other known allergies
Health Insurance Provider Name
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Emergency Contact Name
Emergency Contact Phone Number
Registration and Refund Policy
Registration cost includes transportation, lodging, most meals, and programming content and materials. Full price is required at the time of registration. Refunds are not available. *Financial assistance is available through Young Adults Trips Scholarship Fund. Applications can be submitted through the
Scholarship Request Form
. Scholarship Request Forms are due by May 22 at 11:59 PM. *Any young adult who is not able to attend for the whole trip needs to be approved by the Young Adults Team through an email to GilShelsby@MountainCC.org before 5/22.
Liability Release
I acknowledge that participation in Summer Weekend with Mountain Young Adults involves risk to the participant (and to the participant’s parents, guardians, and family members), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, and personal injury. In consideration for the opportunity to participate in Summer Weekend, the participant acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant accepts personal financial responsibility for any injury or other loss sustained during the Summer Weekend or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the church staff or volunteers. By checking this box, I agree to the above terms and conditions.
Medical Release
Please indicate whether you agree: I give permission for medical attention to be given to me in case of injury, including major surgery.
Medication
Acetaminophen
Ibuprofen
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