REGISTRATION: Young Summer Teen Trip July 8-9, 2026

YOUNG SUMMER TEEN TRIP
July 8–9, 2026 | Mason, Ohio

Get ready for two unforgettable days of fun, friendship, worship, and adventure!
(Payment is due on day you register. Deadline for Registration w/Payment is June 24, 2026)

🌟 Vineyard Youth Conference

🎢 Kings Island

🏨 Overnight Hotel Stay

🤝 Connection with another Vineyard youth group

🍔 Meal Package Included + Additional Dinner Included

🚌 Transportation Included

👕 Trip T-Shirt Included

Cost: $185 per student

This trip is designed for middle and high school students and will be an incredible opportunity to grow in faith, build friendships, and create lasting memories.

💳 PAYMENT INFORMATION

Registration and payment are completed separately.

After submitting this registration form, please complete payment through Vineyard Church's online giving platform.

vccindy.org/give

Important when submitting payment:
Please include your student's name in the "add a message" field.

Example:
"Avery Smith – Summer Trip"

If your family needs assistance with the registration fee, please select that option in the form below. We never want finances to prevent a student from participating.

Questions? Contact Young Vineyard Pastor, Valerie Burton at vburton@vccindy.org

👤 STUDENT INFORMATION

Student First & Last Name

Student Date of Birth

Student Grade (Fall 2026)

T-Shirt Size

👨‍👩‍👧 PARENT/GUARDIAN INFORMATION

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Cell Phone

Parent/Guardian Email

This address will receive a confirmation email

Address

🚨 EMERGENCY CONTACT INFORMATION

Emergency Contact Name

Emergency Contact Phone Number

Relationship to Student

❤️ MEDICAL INFORMATION

❤️ Medical Information

Please provide any information that would help us care well for your student during the trip. If a question does not apply, please enter "None."

Allergies: Please list any food, medication, environmental, or other allergies. If none, enter

Medications We Should Be Aware Of: Please list any medications your student takes that leaders should be aware of. If none, enter

Medical Conditions or Concerns: Please list any medical conditions, restrictions, or health concerns. If none, enter

Parent/Guardian Electronic Signature (By typing your full name below, you acknowledge and agree to the permissions and authorizations included in this registration form.)

Anything Else We Should Know?

🏊 Activity Participation

Will your student be permitted to participate in swimming activities if opportunities arise during the trip?

Yes No

The trip may include access to a hotel pool and Kings Island's water park. Students will only participate in water activities approved by their parent/guardian.

💳 Payment Status

Registration and payment are completed separately. Please let us know how you plan to handle payment for your student's trip. REGISTRATION AND PAYMENT DUE NO LATER THAN JUNE 24, 2026.

How will payment be handled?

I am paying the full $185 registration fee today online with secure give portal: vccindy.org/give I would like information about financial assistance.

Payment Instructions

If paying today or before the deadline, please submit your payment through:

vccindy.org/give

Please include your student's name in the "Add a Message" field.

Example:
Avery Smith – Summer Trip

If you selected financial assistance above, Valerie Burton will contact you with next steps.

⚖️ Liability Waiver, Medical Authorization & Permission to Participate

LIABILITY WAIVER AND RELEASE

I understand that participation in the Young Summer Teen Trip includes travel, recreational activities, amusement park activities, overnight accommodations, swimming activities, and participation in church-sponsored events. I recognize that these activities involve certain inherent risks.

In consideration of my student's participation, I release and hold harmless Vineyard Church, the YMCA, and their respective staff, employees, volunteers, leaders, officers, directors, agents, and representatives from liability for ordinary negligence, claims, demands, injuries, losses, damages, or expenses arising from my student's participation in this event, except where prohibited by law or resulting from willful misconduct or gross negligence.

I authorize Vineyard Church leaders to obtain emergency medical treatment for my student if I cannot be reached immediately. I understand that I am responsible for any medical expenses incurred.

By checking the box below, typing my full name, and submitting this form, I acknowledge that I have read and agree to this waiver and release and that I am the parent or legal guardian of the student listed above.

I have read and agree to the Liability Waiver and Release above.

Yes

✍️ PARENT/GUARDIAN ACKNOWLEDGEMENT

By typing your full name below, you acknowledge that you are the parent or legal guardian of the student listed above and agree to the permissions, medical authorization, and participation information contained in this registration form.

Parent/Guardian Full Name

REGISTRATION: Young Summer Teen Trip July 8-9, 2026

Description

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