WINTERJAM 2010

YPSILANTI, MI

Date: 3/26/2010

Venue: EMU Convocation Center, 799 North Hewitt Road, YPSILANTI, MI Map

START TIME: 7:00PM

COST: $13 (To include: $10 @ Door and $3 travel)

Leave From Williamston 4:15PM EARLIER IF WE CAN!!!!

Doors open at 6:00PM

Show Ends approx. 10:20PM

LINE UP: Third Day, Newsboys, NewSong, Tenth Avenue North, Fireflight, MIKESCHAIR, Robert Pierre, Revive & Guest Speaker Tony Nolan

IMPORTANT:

TO MAKE SURE WE HAVE ENOUGH TRANSPORTATION, YOU NEED TO REGISTER TO PASTOR STONE BY TUESDAY MARCH 23RD TO GAURANTEE YOUR PARTICIPATION. IF YOU DO NOT, YOU WILL NOT BE GAURANTEED TO GO. WE HAVE LIMITED VEHICLES THIS YEAR AND IT IS A FIRST COME FIRST SERVED BASIS.

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Lansing Area and Zone Youth Registration form

For Winterjam 2010 we require permission from parents and/or guardians of youth 18 years or under.

PARENT/GUARDIAN CONSENT AND RELEASE FORM

Lansing Area and Zone Youth Expectations:

* Respect yourself, others and the property of others.

* Follow Leaders instructions.

* Do not use language that is abusive to staff or fellow youth.

* Dress modestly. Shorts should be fingertip length. No string tops.

Parent/Guardian Wavier/Permission:

Lansing Area and Zone Youth does not discriminate due to race or national origin.

I approve the participation of my minor child in Lansing Area and Zone Youth activity and waive any and all claims against the same, its Officers, Leadership Committee, the Church of the Nazarene, Michigan District Church of the Nazarene, Lansing Zone, due to injury or other damages incurred to the activity participant, or said property to the activity participant in connection to the activity named below. I assure that my child is in good physical health and is able to attend this activity listed below.

I authorize the Lansing Area and Zone Youth association to render necessary routine first aid and medical care as required. In the event of an emergency, I give permission to the licensed physician chosen by Lansing Area and Zone Youth association to hospitalize, secure treatment, anesthetize or perform surgery for the activity participant named on this form below. I give permission for Lansing Area and Zone Youth to use my child’s picture (video or photograph) for publicity purposes.

I give permission for _______________________________ to take part in Winterjam 2010- Eastern Michigan University on March 26^th.

Parent/ Guardian Signature: __________________________________________ Date: ______________

Activity Participant Agreement:

I have read and agree to abide by all the rules of Lansing Area and Zone Youth.

Activity Participant Signature: __________________________________

Registration:

Name: ____________________________ Address: ___________________________ City:______________ State:___Zip:_________

Home Phone: ________ Cell:__________

Parent (s) Name:_____________________ Address:____________________________  (If different from above)

Emergency Contact Information

In an emergency, parents are contacted first. List an additional contact person.

Name: ______________  Phone: ____ ____

List Medications: _________________________________________

List Allergies: ___________________________________