2019 Call Conference

Registration Type *

Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Phone Number *

Area Code Phone Number

Gender *

Birthdate *

Date

Grade in school during 2019-20 *

If participant is not in 11th or 12th grade, prior approval must be given by contacting conference leaders via email at thecall@nnu.edu.

Name of person granting prior approval: *

District *

Home Church *

Home Church Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Church Phone Number *

Area Code Phone Number

Home Church Pastor (lead and/or youth) *

In a short essay, recount your Life Story and your current understanding of how God has called and is continuing to call you into ministry. *

(500-600 words)

Who is your role model of a person who has responded to God's call? What characteristics of this person would you like to emulate? *

(250-300 words)

What is one way the church is fulfilling its calling and purpose in the world today? What is one area in which the church can improve and what do we need to do to make that improvement? *

(250-300 words)

Explain your relationship with the student(s) you are mentoring at the Call Conference and describe how you see God's call on his/her/their life/lives. *

Every participant must be recommended to the Call Conference by a Pastoral Reference who is not a member of the participant's family. Please provide the email address of your pastor reference so we can send them a link to our recommendation form.

Pastoral Reference Email: *

example@example.com

Emergency Contact Name *

First Name Last Name

Emergency Contact Relationship *

Emergency Contact Phone Number *

Area Code Phone Number

Emergency Contact Email *

Do you have any special needs we need to be made aware of? (Please provide details in the Other box)

Food Allergies Hearing Impaired Handicap Accessible Vision Impaired

Family Physician Name *

Physician Phone Number *

Area Code Phone Number

List all current medications and dosages

Any known allergies to medications?

Date of last tetanus shot *

Medical Insurance Coverage *

Medical Insurance Company *

Primary Name on Medical Insurance *

First Name Last Name

Medical Insurance Policy Number *

Medical Insurance Group Number *

GUARANTY OF PAYMENT FOR MEDICAL TREATMENT FOR MINOR STUDENT

As the student being registered ("Student") is not covered by any type of health insurance policy or program; the undersigned hereby guarantees payment for any fees, expenses, or costs related to any medical treatment the Student receives in connection with their participation in the 2019 Northwest NYI Field Bible Quiz Finals event. I understand and acknowledge that I may be asked to provide further guarantees of payment to health care professionals and institutions which provide medical treatment to the Student. I also acknowledge that the Church of the Nazarene, Inc., Nazarene Youth International (NYI) and the Northwest Field NYI are not responsible for the cost of Student’s medical treatment and I shall indemnify, defend, and hold harmless Church of the Nazarene, Inc., Nazarene Youth International, the Northwest Field NYI and their respective officers, directors, employees, and/or agents from and against any and all claims which may be made as a result of my failure to provide payment for Student’s medical treatment.

AUTHORIZATION FOR MEDICAL TREATMENT & PARENT/GUARDIAN PERMISSION

In the event I cannot be reached, I authorize and direct any adult Northwest Field NYI employee or volunteer representing the Church of the Nazarene to make emergency medical decisions for the Student. I hereby authorize that emergency medical and/or surgical care may be provided for the Student at my expense. I also hereby release and discharge the Church of the Nazarene, Inc. and its affiliates, along with any other chaperoning adult employees or volunteers of Nazarene Youth International or the Northwest Field NYI, its agents, employees, officers, directors, affiliates, successors, assigns and all other from any and all claims, demands, expenses, personal injury, wrongful death, causes of action, lawsuits, damages, and liabilities of every kind and nature, whether known or unknown, in law or equity, that I or the Student ever had or may have, arising from or in any way related to the Student’s participation in any activities associated in any way with 2019 Northwest Field NYI Call Conference event ("Event"). I have full knowledge as to such activities and I have full knowledge of the probable risks involved. Except for those limitations named in this registration, I certify that the Student is healthy and fit to participate in all such activities.
Further, I acknowledge that NYI and/or its agents will be taking photographs and/or videos of the Event and that the Student may appear in those photographs and videos. I hereby give my permission to the Northwest Field NYI, NYI and/or Church of the Nazarene, Inc. to utilize event media in all forms and in all manners for marketing, promotion, and future event development. I also give my permission for the Student’s contact information to be shared with affiliated Nazarene higher education institutions. In addition, I acknowledge that this release form also includes travel dates to and from the event with the Student's sponsoring district and/or local church.

LOST KEY POLICY

By signing below, I acknowledge that the Student may be issued (i) a Keycard which will allow the Student to access the dormitory and (ii) a separate Room Key which will allow the Student to access the room in which they will be staying during the Event. I further acknowledge that I will be charged $35 for each Keycard and $35 for each Room Key that the Student fails to return upon check out from the Event (i.e., a $70 charge will be incurred if both the Keycard and Room Key are not returned).

PARENT/GUARDIAN SIGNATURE *

Clear

GUARANTY OF PAYMENT FOR MEDICAL TREATMENT

As I am not covered by any type of health insurance policy or program; the undersigned hereby guarantees payment for any fees, expenses, or costs related to any medical treatment I receive in connection with my participation in the 2019 Northwest Field NYI Field Call Conference event. I understand and acknowledge that I may be asked to provide further guarantees of payment to health care professionals and institutions which provide medical treatment to me. I also acknowledge that the Church of the Nazarene, Inc., Nazarene Youth International (NYI) and the Northwest Field NYI are not responsible for the cost of my medical treatment and I shall indemnify, defend, and hold harmless Church of the Nazarene, Inc., Nazarene Youth International, the Northwest Field NYI and their respective officers, directors, employees, and/or agents from and against any and all claims which may be made as a result of my failure to provide payment for my medical treatment.

AUTHORIZATION FOR MEDICAL TREATMENT & PHOTOGRAPHY

In the event I am incapacitated or unable to make a medical decision, I authorize and direct any adult Northwest Field NYI employee or volunteer representing the Church of the Nazarene to make emergency medical decisions on my behalf. I hereby authorize that emergency medical and/or surgical care may be provided for me at my expense. I also hereby release and discharge the Church of the Nazarene, Inc. and its affiliates, along with any other chaperoning adult employees or volunteers of Nazarene Youth International or the Northwest Field NYI, its agents, employees, officers, directors, affiliates, successors, assigns and all other from any and all claims, demands, expenses, personal injury, wrongful death, causes of action, lawsuits, damages, and liabilities of every kind and nature, whether known or unknown, in law or equity, that I ever had or may have, arising from or in any way related to my participation in any activities associated in any way with 2019 Northwest Field NYI Field Call Conference event ("Event"). I have full knowledge as to such activities and I have full knowledge of the probable risks involved. Except for those limitations named in this registration, I certify that I am healthy and fit to participate in all such activities.
Further, I acknowledge that NYI and/or its agents will be taking photographs and/or videos of the Event and that I may appear in those photographs and videos. I hereby give my permission to the Northwest Field NYI, NYI and/or Church of the Nazarene, Inc. to utilize event media in all forms and in all manners for marketing, promotion, and future event development. In addition I acknowledge that this release form also includes travel dates to and from the event with my sponsoring district and/or local church.

LOST KEY POLICY

By signing below, I acknowledge that I may be issued (i) a Keycard which will allow me to access the dormitory and (ii) a separate Room Key which will allow me to access the room in which I will be staying during the Event. I further acknowledge that I will be charged $35 for each Keycard and $35 for each Room Key that I fail to return upon check out from the Event (i.e., a $70 charge will be incurred if both the Keycard and Room Key are not returned).

ADULT SIGNATURE *

Clear

Pre-Conference Preparation Agreement *

I agree to: 1) read "Can You Drink The Cup?" by Henri J. Nouwen (you will need to purchase or borrow this text) and 2) complete the Clifton StrengthFinders assessment via an access code that will be sent to your email address above prior to coming to the Call Conference.

Adult Background Check *

Browse Files

Please upload (a) background check results page(s) that is dated on or after 10/13/2017. This is required for all adult participants.

Registration Fees Early Bird on or prior to 9/16: $100 Standard on or prior to 9/30: $120

Individual Standard Registration $ 120.00

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Total $ 0.00