Emmaus Road Ministries

Register for YE

We're so excited to see you! 

 

Registration Form 

Use the form below to register for all of YE 2017 dates and locations, just select yours from the drop down menu. We are so excited to see you in your city this summer!! 

 
 
Student Information
Name *
Name
Address *
Address
We love to see photos from YE events and we do an Instagram competition at each event!
Emergency Contact Information
Permissions
Permission to Photograph *
I hereby give permission for photographs and/or video in which my child appears in to be used by the ministry in printed and/or electronic media, including the Emmaus Road Website.
By signing below, I hereby agree to the following statements: LIABILITY RELEASE: In consideration of Emmaus Road Ministries allowing the above student to participate in this event, I, the undersigned, do hereby release, forever discharge and agree to hold harmless Emmaus Road Ministries, its directors, employees, volunteers and hosting churches from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above student while involved in our event. Furthermore, we (I) hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in activities involved therein. MEDICAL TREATMENT PERMISSION: We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.