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4/9/2014 10:30 AM

SR HIGH CDYC STUDENT REGISTRATION


June 25-29, 2014 PLEASE fill out completely & legibly!
Church/City __________________________________ PLEASE COPY FORM BACK TO BACK

Name ______________________________________ Male Female
(First) (Last)
Address _______________________________________________________________________
(Number & Street) (City) (State) (Zip)
Phone (______) ________________ Birthdate ______________ Age _______ Grade _______
(current school year)



ROOMMATE REQUEST

1. ____________________________________
(your name)
2. ____________________________________
Your youth director will make final housing assignments
for your youth group.

IWU will ONLY ALLOW 4 people per suite

CDYC and Calvin College Waiver/Release
READ CAREFULLY BEFORE SIGNING.
DO NOT SIGN UNLESS YOU ARE WILLING TO RELEASE CDYC and Calvin College FROM LIABILITY.

I/We agree to abide by the CDYC Guidelines and will allow CDYC to share our contact information with Bethel College and Calvin College. I also give
permission to have videotape or photographs taken of my son/daughter to be used for promotional purposes.
I, the participant, understand that the activities that take place in the Calvin College Recreation and Wellness Center, Troyer Sports Complex, and outdoor
athletic fields are hazardous activities. The activities include but are not limited to swimming, diving, climbing, playing racquetball, running, jogging, walking, jumping,
weight training, playing basketball, dodge ball or related activities, and use of related equipment hereafter referred to as Activities. The hazards inherent in these
Activities include but are not limited to head and spinal injuries, eye or ear injuries, slips and falls, rope burns, cuts, concussions, strained muscles, broken bones, objects
or persons falling on me, falling on objects or other persons, pulled muscles, near drowning, drowning, rope burns, mental and emotional trauma, and communicable
diseases, and other
hazards.
I further understand that these Activities involve a risk of serious injury and even death and caution is required. I assume all risks inherent in these Activities
including the negligent or deliberate act of another person. I understand that the Activities mentioned above are purely voluntary and I participate in them of my own free
will for my personal enjoyment. I am using the equipment and machinery with full knowledge and understanding of the risks involved. I hereby assume and accept any and
all risks of injury or damage while participating in these Activities. I represent to Calvin College that I have the skills and ability to safely participate in these Activities and
that any equipment that I furnish is in good condition, order and repair and is fit for and will be used for its intended purpose. I do hereby declare myself to be physically
sound and suffering from no condition, impairment, disease, or other illness that would prevent or inhibit my participation in these Activities.
In consideration of my being permitted by Calvin College to participate in these Activities I, my heirs, successors, and personal representatives hereby release,
discharge, indemnify, and hold harmless CDYC, The Central Region of the Missionary Church, Calvin College, its Board of Trustees, officers, trustees, agents, and
employees from any and all claims, actions, suits, costs, expenses, injuries or damages arising out of these Activities.
I certify that I have adequate insurance to cover injury or damage, including damage or loss to personal items, that I may cause or suffer while participating in
these Activities, or else I agree to bear the cost of such injury, damage, or loss myself. I further certify that I am willing to assume the risk of any medical or physical
condition I may have. I consent to the provision of emergency medical treatment to the extent that the treatment is necessary in the opinion of a medical professional.
In consideration that the participant is a Minor, this Release remains in full force and effect and that by signing this Release, I affirm that I am the legal guardian
of the Minor and agree and consent to this Release on behalf of said Minor. I hereby grant permission and authorize the provision of emergency medical treatment for
minors or myself while becoming ill or injured in these Activities.
I have carefully read this Release. I fully understand the contents herein. I also understand that I can ask questions about this if I want. If any portion of this
Release is held invalid, the rest of the document shall continue in full force and effect. The interpretation and performance of this Release shall be construed in
accordance with the laws of the State of Indiana, and any litigation arising out of this Agreement shall be venued in the State of Indiana and shall be governed by the laws
of the State of Indiana.

List any medical problems, handicaps, allergies, or medications that should be taken into consideration on a separate paper.


________________________________ ______________________________________ ________________________________
Student Signature Parent Signature PRINTED Parent Name

Date ________________________________________ Emergency Phone Number _______________________________
Health Insurance Co ___________________________ Policy Number _________________________________________



To participate in a sport entry you MUST
register by May 13.
T-shirt size Youth Group: XS S M L XL 2X 3X 4X




REGISTRATION COSTS
A ENTIRE Registration of $ 250 by May 13, 2014
To participate in a sport or talent entry, you MUST register by May 13.

B LATE 1 Registration of $ 260 May 14 31, 2013

C LATE 2 Registration of $ 270 after June 1

ROOMMATE REQUEST:



First Name


Last Name
4/9/2014 10:30 AM

SR High Student Registration Form page 2

Sports Olympics
SEE Sports Olympics Rulebook for complete details for each category.

You may enter BOTH Basketball AND Volleyball.
(please, the sport(s) you would like to participate in.)

SPORT SPORT
3 on 3 Male Basketball Team Coed Volleyball Team
3 on 3 Female Basketball Team Volleyball Free Agent



CDYCS Got Talent

You may participate in THREE Performance entries and TWO Artwork entries.
You MUST bring Performance/Artwork Description Forms with your entry.

PLEASE check the event (s) in which you will participate AND go to cdyc.info/ to download CDYCs
Got Talent Guidelines for entry details and Performance/Artwork Description Forms.

Here are some ideas of what you can perform at CDYCs Got Talent:
Vocal solo or group, instrumental solo or group, preaching, motivational speaking, storytelling, drama, dance solo
or group, bring your band. Have another talent that we didnt mention? Let us know what it is, and we cant wait
to see it. Go to www.cdyc.info/ to download CDYCs Got Talent Guidelines for entry details and
Performance/Artwork Description Forms.

Please describe what you are going to do, how many are involved and what you need.
Entry #1 will be: _________________________________ How many will be performing? _________
What do you need to perform?_________________________________________________________
_________________________________________________________________
Entry #2 will be: _________________________________ How many will be performing? _________
What do you need to perform?_________________________________________________________
_________________________________________________________________
Entry #3 will be: _________________________________ How many will be performing? _________
What do you need to perform?_________________________________________________________
_________________________________________________________________


ARTWORK CATEGORIES:
Each entry needs to reflect this years theme FREE based on Galatians 5:1 which states, It is for freedom
that Christ has set us free. Stand firm, then, and do not let yourselves be burdened again by a yoke of slavery
(NIV 1984).

Drawing/Painting Photography (8X10 or larger)
Poetry Video (How many involved?_____)
Unique Art (collages, sculpture, etc.)
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