• Project Timothy Midwest North

    Everything except payment is included in this form! This form includes your (1) application, (2) liability waiver, and (3) a place for you to select someone to do your recommendation. Once you are accepted you will receive an email with instructions on how to pay the $250 fee.
  • Your Information

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  • Your Parent's Information

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  • Church Information

  • Medical Waiver/Liability Form

    This section is to be completed by a parent or guardian for applicants under 18.
  • I, as parent/legal guardian of the minor(s), understand that my child will be attending Project Timothy at Vineyard Christian Church of Evanston in Evanston, IL. I understand that during this time he/she will be accompanied by volunteers from this and other Vineyards in our region under the direction of staff and volunteers from the Midwest North Region of the Vineyard and Vineyard Christian Church of Evanston.

    I hereby release Vineyard Christian Church of Evanston, as well as any other Vineyard church who provides volunteer staff, their staff and volunteers, and any sponsors of the event, from responsibility and liability for any loss, injury, or illness that my child may sustain during any activity. In the event of an emergency, I understand that every reasonable effort to contact me will be made. In the event that I am unable to be contacted, I hereby authorize an adult leader, as agent for me, to consent to any medical, dental, or surgical diagnosis; X-ray examination; and/or hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state or province where the services are rendered, either at the doctor's office or in any hospital.

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