UUOKC Church Steeple
First Unitarian Church of Oklahoma City Presents...

CongrUUity

Middle School Social Action Conference
February 22-24, 2008

Youth Registration Form

Fill this form out on-line or print this page, fill it out and fax it back off-line.

Event
Name
Home Phone
Cell Phone
E-mail
Street Address
City
State
ZIP
Birthdate (mm/dd/yyyy)
Diet
Allergies or Dietary restrictions
Other Special Needs
Emergency Contact (Name and Relationship)
Emergency Phone Number
Health Insurance Company
Policy Number
Advisor Name
Church (select from list)
Church (if other)
Shirt Size

Liability Release and Emergency Information

I hereby grant permission for _____________________________ to attend the Oklahoma City Middle School Social Action Conference at First Unitarian Church in Oklahoma City on February 22-24, 2008. In the event that an emergency should arise, I grant permission to those in charge to do whatever is deemed necessary to insure his/her safety and well being, and I hereby authorize in advance any medical care deemed necessary. I agree to be held responsible for any such medical expenses. I have completed the medical information above and agree that my child may take the medication(s) listed there. I have also discussed the rules with my youth, and we both realize that failure to follow them could result in his/her removal from the conference.

____________________________________________________________________
Date signed	parent/guardian signature

Youth Agreement to the rules

I have read and understand the rules of the conference and I understand that the consequences of failure to follow them could include my removal from the conference and/or banning me from future conferences. I also understand that I must let the adult leader of my touch group know where I am at all times. I agree to help promote a positive community.

____________________________________________________________________
Date signed	Youth signature