AY Conferences/Camps

AY Conferences/Camps
Welcome to the Assembly Youth Events Registration Form! Check out our exciting events for this year:
You can check your student account balance anytime by logging into your ManagedMissions account.
Student Information
Student's Name*

First NameLast Name
See what trips {studentsName}'s is eligible for!! What is {studentsName}'s grade for the '24-'25 school year? *
Which events are you registering {studentsName} for?
SPRING RETREAT '25
MOTION '25
CAMP '25
Birthday*

MonthDayYear
Date
Gender*

MaleFemale
{studentsName}'s Phone Number or Parent's number. *
Please enter a valid phone number.
T-Shirt Size*
What church do you attend?*

The Assembly: South CampusThe Assembly: Rose District CampusOther
What church do you attend? *

Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Relationship*
Parent/Guardian Cell Number*
Parent/Guardian E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information
Is the emergency information the same as Parent/Guardian information?
Emergency Contact's Name*

First NameLast Name
Emergency Phone Number*
Alternate Phone Number*
Students Medical Information
Is the Student covered by medical insurance? *
Medical Insurance Provider*
Medical Insurance Policy #*
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*
N/A if none.
Is the student taking any medications? If yes, please explain any instructions.*
N/A if none.
List physical or mental handicaps, limitations or restrictions:*
N/A if none.

SPRING RETREAT

Spring Retreat: March 17th-19th | $150 (includes a free T-shirt if you register by March 2nd; $175 after March 2nd). Open to all grades (6th-12th) Your students will spending the night DATES
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Assembly & Assembly Youth during Spring Retreat 2025. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Assembly and all its respective representatives from any and all liability for injuries to said child arising out of participating in, or returning from Spring Retreat.

In case of injury to said child, I hereby waive all claims against The Assembly. There is a risk of being injured that is inherent in all camp activities.
I give my approval.

Motion 2025

Motion Conference: July 23rd-27th | $500. Exclusively for 9th-12th graders.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Assembly & Assembly Youth during Motion Conference 2025. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Assembly and all its respective representatives from any and all liability for injuries to said child arising out of participating in, or returning from Motion Conference.

In case of injury to said child, I hereby waive all claims against The Assembly. There is a risk of being injured that is inherent in all camp activities.
I give my approval.

AY Middle School @ Camp Cargill

AY Middle School Camp: May 28th-31st | $200. Exclusively for 6th-8th graders.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Assembly & Assembly Youth during OYM Summer Camp 2025. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Assembly and all its respective representatives from any and all liability for injuries to said child arising out of participating in, or returning from Camp.

In case of injury to said child, I hereby waive all claims against The Assembly. There is a risk of being injured that is inherent in all camp activities.
I give my approval.

LEADER FORM
We are so grateful for your willingness to serve and make a difference in the lives of our students. Your leadership and dedication are what make these events impactful and life-changing. We couldn’t do it without you!

If you have any questions or need assistance, feel free to reach out. Thank you for being an essential part of this ministry!
Emergency Contact's Name*

First NameLast Name
Emergecny Phone Number*
Alternate Phone Number*

Medical Release and Authorization

As Parent and or Guardian of this student, I understand every effort will be made to contact me first, If the above Emergency contacts cannot be reached, I hereby give permission to the Assembly Youth leaders to hospitalize and or secure proper treatment from my child along with the approval to transport my child to the nearest treatment facility if needed. I agree to accept full responsibility for any and all costs incurred for medical services rendered. In addition, I waive any and all liability and agree that the property owner will incur no liability, implied or otherwise. I also agree with and support the enforcement of the Camp Policies and Procedures.

I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
If applicable do you wish to pay with your student account? You can check your student account balance anytime by logging into your ManagedMissions account. *
If you do not wish to pay with your student account, payment can be processed below.
Spring Retreat
Camp
Motion
You've selected the following:

{youveSelected}

{camp}

{motion}

Be sure to select these in your payment options!

Payment. *

Spring Retreat '25

$175.00

Camp '25

$200.00

Motion '25

$500.00

Enter coupon

Total

$0.00

Credit Card

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

AY Conferences/Camps

Student Information

Which events are you registering {studentsName} for?

Students Medical Information

SPRING RETREAT

Motion 2025

AY Middle School @ Camp Cargill

LEADER FORM

Credit Card