Disciple Now 2024 Registration Form

Disciple Now is a local weekend retreat, for 6th-12th graders, that will empower and connect students of the Cape Girardeau area to grow deeper in their faith in God. Students stay with their friends, in host homes of caring families from our church. Trusted small group leaders facilitate Bible study, prayer, relationship building, and discussion in the host homes.
Students will also meet at Lynwood Baptist Church alongside other students from Cape Girardeau County to participate in large group worship from Kingly with artist Lloyd Nicks and hear a challenging message from pastor Joel Carpenter. On Saturday afternoon, students will participate in a food packing event through Hope International and pack 50,000 meals for local families struggling with food insecurity. Bring your sleeping bag, pillow, Bible, comfy clothes, personal items, and your favorite soda to share!

COST & REGISTRATION

February 5th - Last Day for Early Registration Price only pay $45 (Cost goes up to $60 after)

February 22nd - Final Registration Deadline

Student Name

Gender

Male Female

Grade

Address

Student Cell

Age

T-Shirt Size Adult

S M L XL XXL

Parent Name

Parent Cell

Parent Name

Parent Cell

Parent Email

This address will receive a confirmation email

Please list 2 friends you would like to be paired with for the weekend. We do our best to make sure you are with both of these friends, but due to allergies and housing it is not always possible.

Please upload a photo of your health insurance card - or send a copy with your student to DNOW.

Upload (8MB)

Name of Company

Policy Number

Group Number

In whose name is the insurance?

Family Dr

Dr Phone

Medical conditions we need to know about:

Special dietary needs:

Allergies:

Present Medications:

Wear contacts?

Yes No

Date of last Tetanus

Height

Weight

DOB

I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I (we) cannot be reached, I give my permission for medical treatment to the physician or dentist selected by the adult leaders of the New McKendree United Methodist Church. I understand that my insurance converage will be used as primary coverage in the event a medical emergency occurs. I understand all reasonable safety precautions will be taken at all times by the church and its agents during the events and ativities. I agree not to hold the church leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred.

Agree

My child will stay home if they have experienced any of the following symptoms: fever greater than 99.9 degrees, shortness of breath, cough, chills, muscle pain, new loss of taste or smell, vomiting, diarrhea or sore throat or sore throat in the last 48 hours or have been exposed to anyone confirmed to have a Covid-19 infection in last 14 days, if they are waiting for Covid-19 test results, or if they have any other known contagious illness.

Agree

By participating in programs, services, and activities of New McKendree United Methodist Church, you agree to the following: On behalf of you and your children you hereby release, covenant not to sue, discharge, and hold harmless New McKendree United Methodist Church, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any such program, service or activity.

Agree

For promotional and publicity purposes, I will allow my child’s picture to be taken and used. Names will not be used to identify persons in the pictures.

Agree

Parent Signature

Date Signed

Host home information, packing list, schedule, student driver forms, time away forms, and other information will be included in a DNOW Packet handed out on Wednesday, February 21st at Cox Memorial Hall from 6:00 to 8:00 pm. Packets may also be picked up on February 22nd from 6:00 to 6:30 pm before the first Large Group Session.

The payment options will be emailed after submitting the form.

Disciple Now 2024 Registration Form

Description

Please Fix the Following