Virginia State Youth Convention of the

Church of God Presents

With Special
Guest Speaker

www.theshineeffect.net

To Lead in Worship for

Virginia State
Nathan Heady
http://friendshipcooke
ville.com/

Theme:
Actively Trust

Youth Convention
of the Church of God in Virginia
March 31 April 2, 2017

Lord with all

your heart and

submit to him,
and he will
make your
paths straight.
Proverbs 3:5

Site:
Holiday Inn
2725 Roanoke
St.
Christiansburg,
VA 24073

109.00 +tax per

night

Trust in the

understanding;
in all your ways

$45.00 plus
hotel costs

540 382-6500

Theme Verse:

lean not on
your own

Registration:

Homewood

Camp Christi, Christiansburg, VA

Suites
2657 Roanoke
St.
Christiansburg,
VA 24073
540-381-1394
129.00 + tax per
night

Registration Information
Church Name: ___________________
Contact Person and Telephone Number:
______________________________
Registrations ___ X 45.00 = ________
T-Shirts
Small

___ X 10.00 = ____________

Medium ___ X 10.00 = ____________

Large

___ X 10.00 = ____________

X Large ___ X 10.00 = ____________

XX Large __ X 10.00 = ____________
Total Cost registration
and T-shirt costs

_____________

(Hotel Reservations made by individual churches)

*Registration must be postmarked by February
15, 2017 to insure t-shirts are available.

Hotel and Site Information

Holiday Inn 2725 Roanoke St.
Christiansburg, VA 24073
540-382-6500
$109.00 + Tax per night
Homewood Suites
2657 Roanoke St.
Christiansburg, VA 24073
540-381-1394
129.00 + tax per night
Youth convention Worship Services and
Conferences will take place at Camp
Christi, 4704 Roanoke Street,
approximately 2 miles from the hotels.
Each church is responsible for making
hotel reservations, mentioning the
Virginia State Youth Convention in order

to access this rate. All reservations

must be complete by February 21, 2017.
Registration for VASYC Youth Convention
March 31- April 2nd 2017
Name _____________________________
Age ______________________________
Address ___________________________
_________________________________
Email Address ______________________
Phone Number ______________________
Emergency Contact Numbers:
Father: ___________ Mother:__________
Other:____________________________
Medical Release form complete and
attached? ______________
All monies and registrations should be
postmarked by February 15, 2017 and paperwork
for each student in attendance must be complete.

MEDICAL RELEASE FORM

| Effective dates: March 31 to April 2, 2017 |

Checks should be written to Virginia Youth

Fellowship.
Please print in ink
Name:

Age:
Last

Birthday:
Middle

First

Year in school:

Male

Address:

Female

City:

Phone:

Email:

State:

ZIP: ___________

Cell: ______________________

Medical insurance company Policy: ______________________________

Mother's name:

Phone:

Work: ______________

Father's name:

Phone:

Work: ______________

Emergency contact:

Phone:

Physician:

Office phone: _____________

Dentist:

Work: _____________

Office phone: _____________

Medical History
If necessary, describe in detail the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation,
handicap, disability, or condition to which your child is subject and of which the staff should be aware, and what, if any action of protection is
required on account thereat Submit this notification in writing and attach it to this form. Include names of medications and dosages that must be
taken.
Check the following areas of concern for this student. If necessary, add another page with details:
1. For your child's safety and our knowledge, is your student a[ ] good swimmer [ ] fair swimmer [ ] non-swimmer
2. Does your child have allergies?
[ ] pollens

[ ] mdications

[ ] food

[ ] insect bites

3. Does your child suffer from, or has ever experienced, or is being treated currently for any of the following:
[ ] asthma [ ] epilepsy / seizure disorder
[ ] frequently upset stomach

[ ] heart trouble

[ ] diabetes

[ ] physical handicap

4. Date of last tetanus shot:

5. Does your child wear [ ] glasses

[ ] contact lenses

6. Please list and explain any major illnesses the child experienced during the last year:

Additional comments:

Should this child's activities be restricted for any reason? Please explain:

For your information, we expect each student to conform to these rules of conduct
No possession or use of alcohol, drugs, or tobacco
No students can drive
No fighting, weapons, fireworks, lighters, or explosives
No offensive or immodest clothing
No boys in girls' sleeping quarters and no girls in boys' sleeping quarters
Participation with the group is expected
Respect property
Respect one another, staff, and adult leaders
Respect and comply with event schedules

Students who fail to comply with these expectations may be sent home at their parents' expense.
I, the student, have read the rules of conduct. The above evaluation of my health, and permission to participate In youth group activities. I agree
to abide by the stated personal limitations and code of conduct.
Student Signature:

Date:

Activities may include, but are not limited to: Cookouts, boating, waterskiing, Swimming, basketball, rollerskating, rollerblading, games in the
park, Soccer, broom ball, ice-skating, Volleyball, softball, baseball, camping, Downhill skiing, snowboarding, hiking, biking, concerts, Bible
studies, miniature golf, Hayrides. Note if you desire to limit your child's participation in any event please submit your wishes in writing to the
church pastor prior to that event.
Name of Student:
(hereinafter the "Church")
From
Date

Has my permission to attend all youth activities sponsored by :

to ________________________
Date

This consent form gives permission to seek whatever medical attention is deemed necessary, and
releases the Church and its staff of any liability against personal losses of named child
I/We the undersigned have legal custody of the student named above, a minor, and have given our
consent. for him/her to attend events being organized by the Church. I/We understand that there are inherent
risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees,
agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property
that may occur during the course of my/our child's involvement. In the event that he/she is injured and requires
the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed
physician In the event treatment is required from a physician and/or hospital personnel designated by the
Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising
from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any
medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further,
I/we affirm that the health insurance information provided above is accurate at this date and will to the best of"
my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at
my/our own expense should they become ill or if deemed necessary by the student ministries staff member.
Parent/Guardian signature:

Date: __________________

Please make 1 copy for your records and send this form with your registration.

Youth Council Nomination Form

The Youth Council meets about four to six times per year. The first gathering will take
place Sunday, April 2, immediately following the service at the Convention. Dates for the other
meetings are decided upon at that meeting, as well as the gathering of current contact
information.
There are six members on the council. We try to have a representative from each region
of the state. If you want your region represented on the council, please nominate a responsible
person from your youth group. No more than two youth from each church may serve on the
council. The meetings are lengthy and are hard work. If you dont mind hard work and consider
yourself a leader, then please apply. Please include with this application a one page
statement of your spiritual journey.
Each applicant will be asked to come to an interview with co-council, pastoral advisor,
and member of Ministry of CE and the new council members will be chosen by them.
Please consider prayerfully your nomination for this position. They should be a

Freshman or a Sophomore, and committed servant, a dedicated leader, and

responsible to be at each meeting.

Nomination must be postmarked by February 15, 2017
No nominations will be accepted at the convention. No nominations will be considered unless ALL
PAPERWORK BELOW IS FILLED OUT!!!

Name: ____________________

Age: ___ Year in School____

Address: ________________________________________________
Name of Church: _____________

Telephone #:____________

Pastor: _____________________

Pastors Recommendation:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
________________________
I want to serve on this years youth Council because:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Nominees Signature: _________________________________

Please return this form with Registration Materials.

Conference Leaders and Themes

Standing firm

Al and Crystal Deihl Gordon Road

CHOG/Spotsylvania

Being confident in what you believe

Michelle Moore, FCOG Roanoke

Trusting in His plan for you

Steve Roby Water's Edge Church,
Va Beach

Boldness in prayer

Jay and Verna Jones, with Majesty,Micah

and Major FCOG Roanoke