Participant's First & Last Name *

First Name

Last Name

Gender *

Male

Female

Phone #

(###)

###

####

I would like to stay at a HOST HOME (free) *

Yes

No

Electives

You will choose one of these at the event. Please be deciding which one you would like to choose.

Crafts

Hiking

Gym (off campus)

Skits

Activities at church

Emergency Contact 1 *

First Name

Last Name

Phone *

(###)

###

####

Emergency Contact 2 *

First Name

Last Name

Phone *

(###)

###

####

Parental Release *

I give my child permission to participate in all Youth Awakening 2025 activities January 24-26th, 2025 (or a possible postponed date due to inclement weather). I hereby assume all risks in connection with this entire event and I further hold harmless and release New Life Community Church (NLCC) from any claims, costs, judgments or liability for any injury, illness or damage that may occur while my child is attending the retreat. This release agreement also applies to travel to and from NLCC, and during the retreat (including Free Time Electives). I further give permission for any medical treatment deemed necessary by those in charge of my child, with the full understanding that I will be notified as soon as possible of any such necessity. Permission is also granted to use my child’s likeness, photographs and/or video and sound recordings for broadcast, publication or any lawful purpose. I also understand that typing my name below constitutes an electronic signature verifying that I am the participant's parent/legal guardian.

First Name

Last Name

Today's Date *

MM

DD

YYYY

Participant's Agreement *

I understand that the rules outlined at Youth Awakening 2025 are in my best interest as they insure my safety, my good example and my total retreat enjoyment as well as that of all other participants. Therefore, I agree to abide by the standards of the retreat and understand that a serious willful violation could result in the contacting of my parent/guardian and possible removal from the retreat at their expense, with no refund of retreat cost. I also understand that typing my name below constitutes an electronic signature verifying that I accept this agreement

First Name

Last Name

Today's Date *

MM

DD

YYYY

Please select your payment option

***After submitting the form, you will be automatically redirected to the payment website, regardless of which option you choose

Pay Online (Preferred)

Pay In-Person (Payment wlll be due upon entry to the event)

Name *

First Name

Last Name

Gender *

Male

Female

Phone #

(###)

###

####

Please select your payment option

***After submitting the form, you will be automatically redirected to the payment website, regardless of which option you select

Pay Online (Preferred)

Pay In-Person (Payment will be due upon entry to the event)