GEORGIA DISTRICT FESTIVAL OF LIFE
JANUARY 19-20, 2018
FIRST CHURCH OF THE NAZARENE, DUBLIN, GA
COST: $ 25.00 postmarked by January 5, 2018
Turn in money and forms to your local youth leaders.
Youth Leaders: Send forms along with 1 check for all participants made payable to Georgia District NYI.
Mail forms/money to: Amy Garnto, 1424Walke Dairy Road, Dublin, GA 31021
(Please PRINT all information)
Name:______
Address: ______
(Street)
______
(city) (state) (zip code)
Home phone: (____) ______Cell phone: (____) ______Date of Birth ___/____/______
Age: ______Grade in School: ______Anticipated Year of High School Graduation: ______
Church Name:______
E-Mail Address: ______Circle T-Shirt Size: Small Medium Large XL XXL XXXL
TEEN ENTRANT INFORMATION
GENDER AGE LEVEL AGE LEVEL IN INDIV. SPORTS
___ Male ___ Early Youth (Grade 9 and below) ____ Junior High (ages 12-13)
___ Female ___ Senior Youth (Grade 10 and up)____ Middle High (ages 14-15)
____ Senior High (ages 16-19)
**Exhibition Event
CREATIVE WRITINGINSTRUMENTAL MUSICSPEECH
____ Poetry____ Instrumental Brass Solo____ Impromptu
____ Prose____ Keyboard Solo Instrumental ____ Oral Interpretation
____ Instrumental Percussion Solo ____ Original Oratory
ART____ Instrumental Strings Solo____ Storytelling
____Chalk/Pastels____ Woodwinds Solo
____ Graphic Design____ Instrumental Group(Early Youth/Senior Youth)
____ Mixed Media
____Oil/AcrylicVOCAL MUSICINDIVIDUAL SPORTS
____Pen/Ink____Vocal Solo____ 5K Cross Country Run
____ Pencil____Vocal Duet/with______(Senior Youth/Early Youth)____Swimming
____ Still Photography ____Vocal Small Group____ *Table Tennis
____ Water____Vocal Ensemble____ *Tennis
____ 3-D Art____Vocal Choir____ 100m Sprint
____Singer/Songwriter____Golf
____Worship Band (Early/Senior Youth)
MATH & BUSINESS
CREATIVE MINISTRIES____Math
____ Preaching____Accounting (Sr. Youth only)TEAM SPORTS
____ Dramatic Monologue____ * Co-Ed Dodgeball
____ Dramatic Group(Early Youth/Senior Youth)____ * Co-Ed Softball
____ Interpretive Worship Group(Early Youth/Senior Youth)____ * Co-Ed Ultimate Frisbee
____ Interpretive Worship Solo____ * Ladies’ Basketball
____ Mime/Human Video Group(Early Youth/Senior Youth)____ * Ladies’ Football
____ Mime/Human Video Solo____ * Ladies’ Soccer
____Puppets(Early Youth/SeniorYouth) SCIENCE FAIR____ * Ladies’ Volleyball
____ Sign LanguageNot judged at FOL____ * Men’s Basketball
____Video Productionsee TNT/FOL director for details____ * Men’s Beach Volleyball
____ * Men’s Flag Football
____ * Men’s Soccer
______is a member of the local NYI. ______
(Participant’s name) (Pastor or Local NYI President’s Signature)
Name of Participant: ______
INSURANCE AND MEDICAL INFORMATION
(All participants must be covered by their own personal insurance.)
Please list any medical problems: ______
Allergies: ______
Past Surgeries: ______
Name of medications & dosage you will be taking: ______
List medications you are allergic to: ______
Home Phone: (___) ______Work Phone: (____) ______
Emergency Phone: (____) ______Contact Person: ______
Insurance Company ______Policy # ______
TEEN: I have read the regional Conduct Guidelines and promise to live within these guidelines during Festival of Life. I also promise to cooperate with District sponsors and be under their authority. I am aware that failure to so will result in disciplinary action.______(Teen Signature)
PARENTS: I hereby give authority to Kristi Huff, who is the NYI President of the Georgia District, to obtain necessary medical attention or to authorize treatment at any hospital in the event of a medical emergency. I also recognize the authority of all adult sponsors and the Festival of Life staff as those who will supervise this event and uphold proper conduct. The first step of discipline, should such become necessary, will be a warning and instruction. The second will be a telephone call to the parent or guardian concerning the participation of my son/daughter, ______. I understand that the event of Festival of Life will require my son/daughter to make choices and to keep a schedule, and that he/she may not be under direct adult supervision at all times. I agree to release and hold harmless any and all staff and lay assistants of GeorgiaDistrict NYI and the First Church of the Nazarene, Dublin, GA from any and all claims, suits, costs, and actions of any kind whatsoever, arising from their exercise of the power granted by this authorization, unless due to verifiable negligence. My son/daughter has my permission to attend Festival of Life.NOTE: Valuables should be left at home!.
Parent/Guardian Signature ______
(Signature must be in the presence of a Notary public)
Before me, A Notary Public, in and for said County and State/Province this ______day of ______20__,
personally appeared ______and acknowledged execution of the foregoing.
In Witness Whereof, I have hereunto set my hand and Notary Seal.
State/Province of: ______County of: ______
Notary Public Signature: ______
My Commission expiration date: ______/_____/____ Notary Seal
A COPY OF THIS DOCUMENT IS THE SAME AS THE ORIGINAL.
______
Turn forms and money in to your local church. Youth Pastors/Leaders: Send 1 check for your participants made payable to GEORGIA DISTRICT NYI. Mail check along with registration forms to: Amy Garnto, 1424Walke Dairy Road, Dublin, GA 31021. Applications must be postmarked by January 5, 2018 to ensure a t-shirt in your size. For questions, call (478) 290-1394or email Amy Garnto at .