The Edge Registration Form

THE EDGE REGISTRATION FORM
Registration Deadline: February 24 Please complete this form (front and back), include your first $50 payment, and a signed THE EDGE release form that can be found on our website: www.indepres.org/jh
Student Name _________________________
Address ______________________________
City _______________ State ____ Zip ____
Birthdate ___ /____ /_____ Age______
Grade _______________________________
School ______________________________
T-Shirt Size: (circle one): S M L XL
Parent Name(s) ________________________
M:
Parent Cell(s) _D_:_______________________
M:
Parent Email _D__: _______________________
Notes: _________________________________
_______________________________________
_____________________________________
Is there any medical/health information we need to be made aware of while your child is with us? (ex: allergies, medication, physical limitations, etc.) _________________________ _______________________________________

4738 Walnut Grove Rd. Memphis, TN 38117

SUMMER CONFERENCE
JUNE 22-26
LOOKOUT MOUNTAIN, GEORGIA
COVENANT COLLEGE
@edge_conference on twitter
IPC JUNIOR HIGH

SUMMER CONFERENCE
JUNE 22-26
LOOKOUT MOUNTAIN, GEORGIA
COVENANT COLLEGE
Cost: $460 (completely non-refundable) $50 due April 24 (when making the first payment,
you are agreeing to pay for the entire cost of the trip.) Remaining balance due by May 22
Registration Deadline: April 24
Scholarships are available, so please don’t let the cost of this trip keep you from coming. Scholarship applications
can be found online at www.indepres.org/jh , and must be completed and turned in by April 24.
SPEAKER: Rev. Mark Long
“What Does It Mean To Follow Jesus?”
For more info about The Edge or Covenant College
visit: www.theedgeconference.org and www.covenant.edu
Questions? Contact Brad Robson or Hayden Howel in the church office - 901.685.8206
[email protected] -or- [email protected]

TRIP DETAILS
We’ll meet in the front parking lot of IPC on Saturday @ 7:15 a.m. and leave promptly by 8:00 a.m. “The EDGE Conference is a junior high youth conference centered on the Gospel as well as counselor and student relationships. Located at Covenant College on Lookout Mountain, each five day session of this summer conference is full of exciting activities, sports tournaments, church group times, worship, and gospel-centered teaching.” Tuesday afternoon we’ll head to Six Flags White Water Water Park in Marietta, GA for a fun day in the water! The trip will end with a Thrift Store Party Formal – so make sure to bring your best thrift store outfit! We arrive back at IPC at 6:00 p.m. on Wednesday.
WHO CAN ATTEND:
Rising 6, 7, 8, 9th graders (completed 5, 6, 7 & 8th grade) Friends of our students are always
welcome on these trips!
WHAT TO BRING:
• Sleeping Bag (or sheets and a blanket) • Pillow
• Towels (bath and beach) • Casual and modest summer clothes and shoes
• Toiletries • Bible, pen, notebook • Swimwear and shoes (girls – one pieces/tankinis and guys – no speedos)
• Rain jacket • Flashlight • Spending $$ (for lunch at six flags, 2 meals on the road, snacks, cds, t-shirts, etc.) • Sunscreen • Costume for Thrift Store Formal Dance Party
DO NOT BRING:
• anything of great value that you would be upset see broken or lost. • please no cell phones or electronics

LIABILITY RELEASE FORM - Release of All Claims In consideration for being accepted by Independent Presbyterian Church for participation in the The Edge Summer Conference (June 22-26 2013 in Lookout Mountain, GA, at Covenant College, including the June 25, 2013 trip to Six Flags White Water Water Park in Marietta, GA ) we (I), being 21 years of age or older, do for ourselves (myself) (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless Independent Presbyterian Church, its employees, agents, and the directors thereof, from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever, which may be incurred by the under¬signed and the child-participant that occur while said child is participating in the above described trip or activity.
Furthermore, we (I) and on behalf of our (my) child-participant if under the age of 21 years hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.
Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this partici¬pant. The undersigned further hereby agree to hold harmless and indem¬nify said church, its directors, employees and agents, for any liability sus¬tained by said church us the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto. (If the participant has not attained the age of 21 years.)
We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.
Further, should it be necessary for the participant to return home due to medical reason, disciplinary action or otherwise, we (I) hereby assume all transportation costs.

Name: ____________________________________________

Parent(s) Phone: ____________________________________

Emergency Phone: __________________________________

Hospital Insurance Company: _________________________

Policy Number: ____________________________________

Family Physician: __________________________________

Physician Phone: ___________________________________

Only participants need to sign if 21 years of age or old¬er. If under

21, both parents must sign unless parents are separated or divorced, in

which case the custodial parent must sign.

Father/Mother/Legal Guardian: ________________________

Father/Mother/Legal Guardian: ________________________

Participant (over 21): ________________________________

I HAVE READ THE FOREGOING AND UNDERSTAND

THE RULES OF CONDUCT FOR PARTICIPANTS AND WILL

ABIDE BY THEM AS WELL AS THE DIRECTIONS OF THE

LEADER¬SHIP OF THE TRIP

___________________________________________

Participant

Date