Youth Conference Registration

Participant First Name

Please include the Participant's First Name

Participant Last Name

Please include the Participant's Last Name

Participant Birth Date - Youth Age 14 and up Youth age 13 are permitted if their
14th birthday occurs during 2024.

Please include a valid date of Birth for the Participant

Participant Gender

Please select the Participant's Gender

Participant Email

Please include a valid email address

Participant Phone

Please include a valid Phone number

Ward

Please select a Ward

T-Shirt Size (Men's Sizes)

Please choose a T-Shirt Size

Emergency Contact (Parent/Guardian)

Emergency Contact Name (Parent/Guardian)

Please include an Emergency Contact Name

Emergency Contact Email (Parent/Guardian)

Please include a valid email address

Emergency Contact Phone (Parent/Guardian)

Please include a valid Phone number

Address

Please include a valid address

City

Please include the City

State

Please include the State

Zip

Please include the Zip Code

Medical Information

Does the participant require a special diet?

Yes No

Does the participant have any allergies?

Yes No

Is the participant taking any medication or over-the-counter (OTC) drugs?

Yes No

Physical Conditions That Limit Activity

Does the participant have a chronic or recurring illness?

Yes No

Has the participant had surgery or a serious illness in the past year?

Yes No

Identify any other limits, restrictions, or disabilities that could prevent the participant from fully participating in the event or activity.

Other Accommodations or Special Needs

Identify any other needs or considerations the participant has that the event or activity planner should be aware of.

Permission and Medical Release

I give permission for my child or youth to participate in the event and activities listed above (unless noted) and authorize the adult leaders supervising this event to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this event and travel to and from this event.

Please note: Units may not have the ability to meet all medical, physical, and other accommodations and are asked to counsel with parents or guardians on what is possible.

The participant is responsible for his or her own conduct and is aware of and agrees to abide by Church standards, camp or event safety rules, and other pertinent instructions. The participant’s conduct and interactions should abide by Church standards and exemplify Christlike behavior.
Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoked if participants behave inappropriately or if they pose a risk to themselves or others.
This information is collected to help event and activity leaders or medical personnel so they can be prepared and appropriately respond to health concerns or an emergency. It will be kept confidential and shared only as needed.

You must agree before submitting.

I understand that my child/youth must behave in accordance with Church standards. If a member of the Stake Presidency determines that my child/youth must be sent home due to behavioral issues, medical reasons of any kind, or at the request of my child/youth, I understand and agree I am responsible for any costs incurred to transport my child/youth home early. Prior to reaching such a decision, a member of the Stake Presidency will communicate with me to inform me of the decision.

You must agree before submitting.

Participant Release

(Release to Use Name, Image, Voice, Likeness, and Performance)

I irreversibly grant to Intellectual Reserve, Inc., its related entities, and their respective employees, agents, and representatives (collectively called “IRI”), the full right to create and obtain, in the past, present, and in the future, images, photographs, video, audio, interviews, stories, personal histories, performances (vocal, instrumental, dramatic, or otherwise), mixes, and any other recordings, documents, or materials, in any now known or future media, of my name, image, voice, likeness, performance, and other items (collectively called “Recordings”). I also authorize IRI to copyright, adapt, edit, translate, summarize, reproduce, perform, display, distribute, publish, license, sublicense, sell, broadcast, post or stream over the Internet, and otherwise use and allow others to use any and all parts of the Recordings, forever and throughout the world, in any and all manners, and in any and all forms of media that IRI believes suitable.

I agree that I shall have no right, title, or interest in or to the Recordings (or to any work comprising or based on the Recordings, in whole or in part), and that all right, title, and interest in and to the Recordings belongs to IRI. I waive any and all right to payment or other compensation arising from or related to the Recordings. I will not state or imply, or allow others to state or imply, that IRI approves of or endorses me or my activities. I further agree to release, defend, and hold IRI harmless from any claims, damages, or liabilities related to the Recordings or IRI’s use thereof. I understand this Release is governed by the laws of the State of Utah, U.S.A.

Parent/Guardian Consent (If participant listed above is a minor)
I, the undersigned, hereby warrant and represent that I am the parent or legal guardian of the minor child named above (the “Youth”), that I have full authority to execute this Release on behalf of the Youth, that I have read this Release, and that by signing below I have granted this Release on behalf of the Youth. I hereby agree that I, the Youth, and all other parents or legal guardians, if any, will be bound by all releases, consents, and covenants contained in this Release. I further agree to indemnify and defend IRI against any and all liabilities relating to the Youth’s actions in connection with the Recordings or IRI’s use thereof.

You must agree before submitting.

Electronic Signature Consent

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

You must agree before submitting.

Participant Signature is Required

Parent/Guardian Signature is Required

Success!

Youth Conference 2024

Registration Form

Participant Information

Emergency Contact (Parent/Guardian)

Medical Information

Physical Conditions That Limit Activity

Other Accommodations or Special Needs

Permission and Medical Release

Participant Release

(Release to Use Name, Image, Voice, Likeness, and Performance)

Electronic Signature Consent