Please fill out all of the lines below. For Youth/Group Leaders, be sure your information is filled out before you fill out individual information for your students.
Remember that due to obligations YFC incurs in advance of the event, registrations are non-refundable but are transferable to another person in your same group. If you need to make a registration transfer, please contact our office by email or by phone: 518.533.3617.
(Enter N/A for Leaders)
MEDICAL RELEASE FOR STUDENTS UNDER 18 YEARS OF AGE
In signing below as Parent or Guardian of the Individual registered, you release Youth for Christ from any and all liability for your child in case of accident or illness and authorize any medical care deemed necessary by an accredited physician, nurse or hospital while traveling to and from and while attending Breakout 2016, January 15-17, 2016 in Saratoga Springs, NY.
Break Out will be held as scheduled, regardless of weather conditions. Registration fees are non-refundable, but are transferrable to another member of your group
In registering, you give permission to Youth for Christ and its video/audio production staff to use your name, voice, video image and/or photo in future promotional pieces, in broadcasts and on related Youth for Christ websites.
This field is for validation purposes and should be left unchanged.