Rise Youth Convention 2019

I, {parentguardian}, certify that {name} may attend Rise Youth Conference in 2019.

Knowing the risks that may occur at Nebraska Youth Convention (i.e. services may contain loud noises, flashing lights, a hazer/fog machine, and other multimedia experiences, crowded hallways, and other risks associated with large events), we agree, on behalf of ourselves and our child, family, heirs, and personal representatives, to assume all the risks and responsibilities surrounding our child’s participation in the above-described risks, both known and unknown. To the maximum extent allowed by law, we release, hold harmless, and agree to indemnify the General Council of the Assemblies of God, Nebraska District Council of the Assemblies of God, and any Assemblies of God church and/or any Assemblies of God school, college or university and their officers, directors, employees, volunteers, and agents, from and against any present or future claims, losses, liabilities, costs and expenses for injury to person or property, or for any other damage, which our child may suffer, or for which our child may be liable to any other person, related to our child’s participating in said activities, resulting from any cause, including but not limited to negligence on our child’s part or on the part of any of the released parties; provided that this release of liability shall not apply to gross negligence or willful or wanton misconduct. The authorized on-site representative is responsible for obtaining proper medical forms for each student and other leaders.

I allow my student to participate in recreational activates including but not limited to: Playground, Various field games (splash kick ball, soccer, flag football, etc.), Dodge Ball, Basketball, Indoor swimming pool, Go-Carts, Gyro, Sand Volleyball.

Weekend 2: I also understand that participants at The Crossing at Lexington are liable for damage caused intentionally or maliciously.  Damage caused by a participant will be billed directly to the participant responsible and their legal guardian.

Permission is given to Nebraska District Assemblies of God to use photographs (individual or group) and/or multimedia images and recordings in the best interest of Nebraska District Assemblies of God.

Knowing the risks that may occur at Nebraska Youth Convention (i.e. services may contain loud noises, flashing lights, a hazer/fog machine, and other multimedia experiences, crowded hallways, and other risks associated with large events), I agree, on behalf of myself and family, heirs, and personal representatives, to assume all the risks and responsibilities surrounding my participation in the above-described risks, both known and unknown. To the maximum extent allowed by law, I release, hold harmless, and agree to indemnify the General Council of the Assemblies of God, Nebraska District Council of the Assemblies of God, and any Assemblies of God church and/or any Assemblies of God school, college or university and their officers, directors, employees, volunteers, and agents, from and against any present or future claims, losses, liabilities, costs and expenses for injury to person or property, or for any other damage, which I may suffer, or for which I may be liable to any other person, related to my participating in said activities, resulting from any cause, including but not limited to negligence on my part or on the part of any of the released parties; provided that this release of liability shall not apply to gross negligence or willful or wanton misconduct. The authorized on-site representative is responsible for obtaining proper medical forms for each student and other leaders.

Western Location: I also understand that participants at The Crossing at Lexington are liable for damage caused intentionally or maliciously.  Damage caused by a participant will be billed directly to the participant responsible and their legal guardian.

Permission is given to Nebraska District Assemblies of God to use photographs (individual or group) and/or multimedia images and recordings in the best interest of Nebraska District Assemblies of God.

Please make out your check to NYM and include the attendee's name on the memo line or in a note with the check.

Mail your check to:

NYM
PO Box 1965
Grand Island, NE 68802

By selecting "Through my Church" you are required to send your payment to your church.  Provide a contact person below that will be notified of your intention to pay through your church.