IYPU Registration 2025

Form Disclosure

By filling completing this form I agree that IBW and IYPU youth ministry is released from liability in connection with medical treatment and unavoidable accidents. IYPU youth ministry also has permission to use necessary medical measures in the event of an emergency. My child has permission to leave the grounds with authorized staff for scheduled trips and outings.

I fully understand the inherent risks involved in the activities my child will be choosing or has chosen. I accept all risks including those activities preliminary and subsequent to the chosen activities. Also, I give IYPU youth ministry permission to utilize my child's photographs or likeness in promotional materials.

I have read and agree to the fees, conditions, and policies outlined in this form.

Child's Information:

Child's Name

Child's T-Shirt Size

X-Small Small Medium Large X-Large XX-Large

Child's Phone Number

Parent/Guardian's Information:

First Name

Last Name

Phone

Your Email

This address will receive a confirmation email

Home Address

Insurance & Health Information:

For any information that does not apply, please answer with N/A.

Please list any significant health conditions the child may have below:

Please list any food or medicine allergies the child may have below:

Health Insurance Provider

Health Provider's Phone Number

Health Care Plan Type

Insurance I.D. or Policy Number

Insurance Group Number

Church Information:

Your Church Name

Your Pastor's Name

Authorization Certification & Liability Release Disclosure

By submitting my payment to IYPU Youth Ministry I authorize any medical treatment required if my child becomes ill or involved in an accident.

I give any representative of the International Bible Way Church or the IYPU Youth Ministry permission to administer or take my child for authorized treatment. I accept responsibility for any expenses incurred in the medical treatment for my child and assign all coverage to any healthcare provider from my healthcare plans as noted above.

In consideration of the assistance of the church staff in organizing Youth Ministry activities, I release the church, all of its personnel, and any affiliates or assistants who function or accompany children on outings and activities, from all liabilities or claims while my child goes to, attend, or returns from any Youth Ministry activity; I assume all risks involved. This "release" is given on behalf of me, my child, and all family members.

Payment Information:

The deadline for All Access Pass Registration is Friday, June 27th, 2025. The All Access Pass package includes the following:

-Registration package
-IYPU T-shirt
-Lunch
-Access to IYPU Workshops & Activities and more

Note: General pass will pay for certain events separately.

IYPU Registration Options:

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form in its entirety. If you have any questions or concerns please email registrar@internationalbibleway.org.

IYPU Registration 2025

Description

Please Fix the Following