ࡱ> PRO ++bjbjWW 4@==+#``<7%" ($$$$$$$$Y')D$000$$DDD0"$D0$DDrJ!TJ"PɕR!$%07%!?*d?*J"J"?*^"D00D00000$$D0007%0000?*000000000` i: REGISTRATION FORM Youth and Adult Youth Advisors must complete and submit the form below to register for all youth conferences in MidAmerica. This registration form may be printed out and mailed to: MidAmerica Region of the UUA, 2355 Fairview Ave., #312, Roseville, MN 55113 Registration Type (circle one): youth adult staff Grade Level : ___________ Age: ________ Birth Date (mm/dd/yy): ___/___/________ First Name: ________________________Last Name: ______________________________ Address: ____________________________________________________________________ City: _________________________________State: ________ Zip:____________________ Name of parent/guardian at this address: ____________________________________________________________________________ Phone #: (____) __________________Email:______________________________________ Congregation/Church/Fellowship:_______________________________________________ Dietary Preference (circle one): omnivore vegetarian vegan # of Cons Attended (circle one): 1 2 3 4 5 6 7 8 9 10+ I am interested in receiving a scholarship (circle one): YES NO Registration Fee Paid: $_________ How will fee be paid (circle one): check by mail online with credit card staff-not applicable I have read the Conference Rules and Code of Ethics/Conduct (circle one): YES NO Date submitted: _________________________ Please Complete the youth Permission and Health Forms below and give to registrar when checking into the conference. Permission & Supervision Form (Please complete and present form to registrar when signing in at the conference.) Date: ___________________________ Attendee Name: ______________________________________________________________ Congregation: _________________________________________________________________ YOUTH: List adult sponsor(s) attending from your church: 1.____________________________________________ 2____________________________________________ 3.____________________________________________ 4.____________________________________________ I have read and will uphold the Youth Conference Rules. If I do not follow these rules, I may be expelled from the conference. Signature: ______________________________________________ Date: _________________ PARENT/GUARDIAN: In the event that my child is asked to leave the conference, I accept all responsibility for the safe removal of my child. My child has my permission to ride to and from the conference with the following persons: 1._____________________________________________ 2._____________________________________________ Signature: ______________________________________________ Date: _________________ ADULT SPONSORS: I have read and will uphold the Youth Conference Rules. If I do not follow these rules,I may be expelled from the conference. Signature: ___________________________________________ Date: _________________ List the names of youth under your supervision while attending this Conference: 1__________________________________________________________________________ 2._________________________________________________________________________ 3._________________________________________________________________________ 4__________________________________________________________________________ 5__________________________________________________________________________ 6.__________________________________________________________________________ 7.__________________________________________________________________________ 8.__________________________________________________________________________ 9.__________________________________________________________________________ 10._________________________________________________________________________ Youth Conference Rules and Code of Ethics (Must be read and signed by all Adult Sponsors and Older Youth in Leadership Roles) Rules: All rules apply equally to youth and adults. For liability reasons and conferee safety. Enforcement of the conference rules is the responsibility of EVERY conferee with overall supervision by leadership. Adults in general are not expected to be the primary rule enforcers, but are expected to be full conference participants. Adults and youth leaders are expected to serve as good role models and to have a signed code of ethics when they check in at conferences. Attendees will remain on site at all times At least 1 adult per 10 youth from each church must be present (1-7 for Jr. High events) Being outside designated areas at any time is prohibited Illegal use of alcoholic beverages, illegal drugs and weapons are prohibited NO SEXUALIZED BEHAVIOR Everyone must attend all mandatory planned activities Caffeine pills and other unnecessary drugs are not allowed Sleeping is required at training conferences Self-care including rest are essential for a good experience Smoking is not condoned during the conference for youth or adults Sexual behavior which detracts from the conference community will not be tolerated Adhere to site rules Cars are off limits during the con except for approved con business In the event of a rules infraction, the Conference Rules Committee will be convened to determine the consequences of the rule infraction. Code of Ethics for Adults, Older Youth and Youth in Leadership Roles with Youth Based on the Code of Ethics for Adults, Older Youth, and Youth who are in leadership roles with Children and Youth, adopted by the Unitarian Universalist Association in 1986. Adults, older youth, and youth who are in leadership roles are in a position of stewardship and play a key role in fostering the spiritual development of both individuals and the community. It is therefore especially important that those in leadership positions be well qualified to provide the special nurturing, care and support that will enable youth to develop a positive sense of self and a spirit of independence and responsibility. The relationship between young people and their leaders must be one of mutual respect if the positive potential of their relationship is to be realized. There are no more important areas of growth than those of self-worth and the development of a healthy identity as a sexual being. Adults play a key role in assisting youth in these areas of growth. Wisdom dictates that youth and adults suffer damaging effects when leaders become sexually involved with young persons in their care; leaders will therefore refrain from engaging in sexual, seductive or erotic behavior with youth. Neither shall they sexually harass youth nor engage in behavior with youth that constitutes verbal, emotional or physical abuse. I, _______________________________________, as a youth leader, an older youth (over 18) or an adult, recognize my position of power and have read and understand the above statements of position, expectations and actions and agree to follow the Code of Ethics. **Signature: __________________________________________________Date:___________ Youth Conference Emergency Form (To be filled out by all Conference Attendees) Attendees Name: _________________________________________________________________ Name of Parent(s)/Guardian(s): _____________________________________________________ Parent(s)/Guardian(s) Phone # (____) _____________________ Physician: ____________________________________ Phone #: (_____) ______________________ Insurance Company: ______________________________________________________________ Policy Holder: __________________________________ Policy #: ____________________________ Allergies: ___________________________________________________________________________ Health Conditions: __________________________________________________________________ Please list any medications you are taking (and reason): __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Please list two people, other than parents, that we can contact in an emergency who can legally provide authorization for medical treatment. Name: ___________________________________________ Phone: (_____) ___________________ Name: ___________________________________________ Phone: (_____) ___________________ Please check one of the following and sign: _____ I Request Medical Treatment for my child without prior notification. _____ I Request NO Medical Treatment for my child without prior notification. In the event of an emergency, I understand that the camp coordinators will try to contact me. If I am unable to be reached, the coordinators will do their best to ensure the safety and health of my child, __________________________________________________________________ (Insert childs name) I do not hold the MidAmerica Region liable in the event of an emergency. 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