First Name *

Last Name *

Gender *

Email Address *

Mobile Number *

Allergies

Tip: Please list all food, pet, common allergies so we can best accommodate you. We cannot help if we do not know.

What LifeGroup are you currently leading? *

Are you willing to drive students in your car? *

How many seats do you have total? (including the driver) *

Tip: Seats must have a seat belt to be considered a seat.

First Name: *

Last Name: *

Phone Number: *

Phone Number #2:

Host Home Stay: *

Tip: I, the undersigned, understand that leading a Youth LifeGroup includes spending the night in the Host Homes with the students both Friday and Saturday nights. If I have not already, I agree to complete a background check and attend our IGNITE 2024 Leader Training prior to serving in this capacity. If I am unable to stay the night due to medical reasons, I understand that we will need to find another leader to stay in the home with my students since at least 2 leaders are required.

Photo Release Form: *

Tip: I, the undersigned, authorize the youth directors, youth ministry leaders and GraceLife Church in Columbia, SC to use photography of myself, named below, in the use of youth ministries, GraceLife Church activities and functions. I will not hold the youth directors, youth ministry leaders, GraceLife Church or the specific photographer responsible for misuses of the photography related to circumstances of public domain, computer hacking/viruses/theft or other circumstances where the use of the photograph was not authorized (verbally or written) by the youth directors, youth ministry leaders or GraceLife Church.

Medical Release Form: *

Tip: I, the undersigned, authorize the youth directors and leaders of GraceLife Church in Columbia, SC to make medical decisions should I, named below, encounter a medical emergency and I cannot be reached after a reasonable effort. I will not hold the youth directors of GraceLife Church or the leaders of GraceLife Church responsible for any harm that may come to my student as a result of any emergency medical procedure they authorize in my absence as a result of my inability to be reached.

General Reliability Release Form: *

Tip: I, the undersigned, authorize the youth directors and the leaders at GraceLife Church in Columbia, SC in the general welfare of myself, named below, during all youth ministry activities. I give permission to be transported by the youth directors and leaders of the youth ministry, and will not hold the youth directors, leaders of youth ministry or GraceLife Church liable for any harm, injury or death that may come from a transportation accident, unforeseen circumstances or circumstances beyond their control. I also will not hold the youth directors, leaders of youth ministry or GraceLife Church in Columbia, SC responsible for any harm, injury or death that may result from activities at a student ministries event provided that reasonable steps were taken to ensure my student(s) safety.

E-signature: *

Tip: I understand that this e-signature carries the same weight as my actual signature. I confirm that by typing my name that this is my legal consent.