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Step UUp Junior Youth Con Registration

Step UUp Junior Youth Con Registration

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Published by YACNNED2869
Registration form for the Step UUp Junior Youth Con in Auburn May 2-3, 2009
Registration form for the Step UUp Junior Youth Con in Auburn May 2-3, 2009

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Categories:Types, Business/Law
Published by: YACNNED2869 on Apr 02, 2009
Copyright:Attribution Non-commercial


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Step UUp, Meet and Greet Con
Junior Youth ConMay 2-3, 2009 at Auburn First Universalist Church
Northern New England District
Registration Form(6-8
Send this completed form and payment of $15 (payable to NNED, memo ME junior youth con) to JoyBlanchette at 10 Ferry St #318, Concord, NH 03301 or fax to 603-226-3011 by the deadline, April 17.
Street city state zip
Phones (H)_______________(cell)______________email______________________
Print legibly
Allergies/medical conditions/specialneeds_____________________________________________________________Your adult sponsor/advisor
(at thiscon)________________________________________________________ 
 Your congregation___________________________________________________Emergency contact (name and relationship toyou)_______________________________________________________________Emergency phone # of above(H)_________________(w)_________________cell_______________How many cons have you attended?____Who is driving you?_________________ “I understand that this youth from my church is attending the stated event”  __________________________________________________________________
Signature of DRE, minister, or youth coordinator
Community CovenantI understand each youth conference community strives to be inclusive, healthy andspirit-centered. Realizing that what I do and how I act affects other youth, adultadvisors, parents, religious educators, ministers, the district and the UU movementI promise to observe the following guidelines.
Usage of, holding or distribution of illegal substances such as alcohol, drugs,or tobacco or weapons is not allowed
Appropriate, non-violent, and respectful language and behavior is expected
Respect for others, the physical premises and others’ personal property
No sexual intercourse of any kind and no overt sexual behavior
Abide by sleeping arrangements (one blanket/bag: one person)I understand that failure to follow these guidelines could include my removal fromthe event at my parents’ expense. I also agree not to leave the set boundaries of the event without permission.Youth signature___________________________________________Date______
(one of two pages for youth)
Parents/guardians please read and complete
Liability release and emergency care authorizationMEDICAL EMERGENCY PARENTAL PERMISSIONThe health history for my child is correct and complete to my knowledge. If an injuryor other medical condition occurs or arises, I hereby give permission to the NNEDstaff or volunteers to provide routine health care and seek emergency treatmentincluding x-rays or routine tests. I agree to the release of any record necessary fortreatment, referral, billing or insurance purposes. I understand that I am financiallyresponsible for charges and hereby guarantee full payment to the attendingphysicians or health care unit. In the event of an emergency where I cannot decidefor my child, I give permission to the physician/hospital selected by the District staff or volunteer to secure and administer treatment for my child, includinghospitalization. _________initial __________datePUBLICITY/IMAGE/VOICE PERMISSIONThe District staff or volunteers may wish to take photographs, video, and/or taperecording of youth events. During activities, a photograph or video/audio recordingmay be taken of you or your child. Unless you request otherwise, your initial belowwill be considered permission for NNED to photograph, film, audio/video tape, recordand/or televise your image and/or voice or the image and/or voice of your child foruse in any publications or promotional materials, in any medium now known ordeveloped in the future without any restrictions. If you object to NNED using you oryour child’s image or voice in this manner, please notify the NNED programconsultant. _________initial __________dateASSUMPTION OF RISK AND RELEASE OF LIABILITY (
Please read carefully.
)I give permission for to participate in the NNED youth events. Iunderstand that NNED activities/events may involve certain risks of physical activityand possible injury and that NNED will provide each participant with reasonable care,but that NNED cannot guarantee that my child will remain free of injury. In addition,some NNED youth events including but not limited to: winter sports, water activities,and other sporting activities have a higher degree of risk. I nonetheless wish to havemy child participate in NNED youth ministry events and ASSUME the RISK of participating. I agree to RELEASE from LIABILITY, INDEMNIFY and HOLD HARMLESSthe NED, the Board of Directors and their officers, employees and agents (hereinafterthe RELEASEES) from any and all claim and/or cause of action arising out of andrelated to any injury, loss, penalties, damage, settlement, costs or other expenses orliabilities that occur as a result of my child’s participation in the NNED youthprograms.P
arent or Guardian Signature Date(Must be signed by the parent or guardian if the participant is under 18 years old)
Step UUp, Meet and Greet Con
Junior Youth ConMay 2-3, 2009 at Auburn First Universalist ChurchAdult Registration Form
Send this completed form and payment of $15 (payable to NNED, memo ME junior youth con) to JoyBlanchette at 10 Ferry St #318, Concord, NH 03301 or fax to 603-226-3011 by the deadline, April 17
Name___________________________________________________________Gender____________Address___________________________________________________________________________Street city, state zipPhones (H)__________________ (W)____________________ cell_____________________Email_____________________________________________________________________________Congregation_______________________________________________________________________Emergency contact information (name andrelationship_______________________________________________________________________Phones(W)__________________(H)____________________________cell___________________________How many cons have you attended?________________ “I recognize that this adult will be sponsoring youth to the stated event and has completed thedistrict’s or church’s screening process”  __________________________________________________________________________________
(Signature of religious educator, minister, youth coordinator)I will be sponsoring the following youth (name and congregation* if different from yours)1.______________________________________2.____________________________3. _____________________________________4. __________________________5. _____________________________________6. __________________________* Parents and DREs/staff must understand that you are sponsoring a youth from their church
Adults and older youth who are in leadership roles are in a position of stewardship and play a key rolein fostering spiritual development of both individuals and the community. It is, therefore, especiallyimportant that those in leadership positions be well qualified to provide the special nurture, care, andsupport that will enable children and youth to develop a positive sense of self and a spirit of independence and responsibility. The relationship between youth and their leaders must be one omutual respect if positive potential is to be realized. There are no more important areas of growth thanthose of self-worth and the development of a healthy identity as a sexual being. Adults play a key rolein assisting children and youth in these areas of growth. Wisdom dictates that children, youth, andadults suffer damaging effects when leaders become sexually involved with young persons in theircare; therefore leaders will refrain from engaging in sexual, seductive, or erotic behavior with childrenand youth. Neither shall they sexually harass or engage in behavior with youth that constitutes verbal,emotional or physical abuse.By signing below, the signer indicates s/he has been informed of this code and agrees to abide by itbefore assuming their work with children and/or youth involved in District activities. In cases of violation of this code, appropriate action will be taken.Signed_______________________________________________________Date_________________(continued below)

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