Youth Force Claremore 2023
Registration form for youth and adults to attend Youth Force Claremore 2023
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Email *
First Name *
Last Name *
Home Church *
Grade in Fall 2023 *
Gender *
Date of Birth mm/dd/yy *
MM
/
DD
/
YYYY
Address *
City *
State *
Zip Code *
 Phone Number *
Email *
Emergency Contact  Name *
Emergency Contact  Relationship *
Emergency Contact  Phone # *
Alt Emergency Contact  Name *
Alt Emergency Contact  Phone # *
T Shirt size *
List any relevant tool proficiencies
Company Issuing Medical Insurance (if none write none) *
Policy Number
Family Name on Policy
Insurance Company Phone Number
Allergies *
Have You Been Fully Immunized?
 *
Date of Last Tetanus
MM
/
DD
/
YYYY
Current Medications: Please turn into the nurse first thing in original prescription bottle(s)
Any Preexisting Medical Issues? i.e.- Heart Conditions, Seizures
Are there any significant life events that continue to affect the participant's life that we should know about?
Any Food Restrictions? *
Can the Participant Take Over the Counter Medications? *
I agree to hold the Oklahoma United Methodist Annual Conference AND/OR all leaders of this event free from liability for any injuries, damages or losses unless caused by the willful or intentional conduct on the part of the leader and the staff.  I understand Youth Force assumes no financial responsibility or liability for medical conditions, preexisting or incurred while at Youth Force. *
I hereby give permission to the physician or hospital staff selected by the Youth Force leadership to order X-rays, routine tests, and treatment for the health of the participant. *
In the event I cannot be reached in an emergency, I hereby give permission to the physician and hospital staff selected by the event leadership to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for this participant. *
This participant has permission to engage in Youth Force activities, agrees to participate fully in the features of the program and cooperate in maintaining an atmosphere of Christian fellowship. *
I consent to the use of this participant's image or voice in photographs, audio and/or video recording taken during the course of this event for the purpose of publicizing the Youth Force program of the Oklahoma Conference of the United Methodist Church of Youth Force. *
Electronic Signature of Participant *
Electronic Signature of Participant's Parent or Guardian if under 18 years of age. *
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