Winter Xtreme Registration
Please completely fill out the form below to register for Winter Extreme 2018.
Student Name:*
Student E-mail:*
Student Birthdate:*
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Student Phone:*
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Grade:*
Parent/Guardian Name:*
Parent/Guardian E-mail:*
Parent/Guardian Address:*
Main-Phone:
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Secondary Phone:
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Work Phone:
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Emergency Contact Name:*
Relationship to Student:*
Main Phone:*
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Secondary Phone:
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Medical Insurance Policy Name:*
Policy Number or ID Number:*
Primary Clinic: *
Name of Primary Physician:*
Physician's Phone:
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Has this student had an injury requiring medical attention in the past year?*
Please list the injuries here:
Is this student currently taking any prescription or non-prescription medications?*
Please list the medications here:
Have you ever become ill from physical activity?*
Please explain what happened:
Has this student been hospitalized in the past year?*
Please explain the circumstances for hospitalization:
Do you have any allergies?*
Please list the allergies and cosequences:
Do you have asthma?*
If you have asthma, do you have an inhaler:*
Please describe the heart condition:
Do you have any heart conditions? *
Do you have any medical conditions requiring treatment or medication? *
Please describe the conditions requiring medication, and the medications needed:
Do you have any conditions which may limit participation in camp activities? *
Please describe the conditions and limitations on camp activity:
Please provide immunization history below. Include the kind and dates of immunizations (DTP, TD or TDAP, MMR, etc.). Also, indicate positive or negative for TB: :*

Medical/Dental Consent:  I authorize This Generation Ministries and Faith Harbor Fellowship, in whose care my child has been entrusted, to (1) facilitate the taking of my child’s prescribed medications; (2) administer routine medical care for minor injuries and illnesses; and (3) in my absence, consent to any emergency medical, surgical, or dental diagnosis or treatment, and hospital care to be rendered to my child on the advice of any licensed physician, dentist, or other health care provider, and I will be responsible to pay all costs incurred in connection with such medical and dental services.

Release:  For myself and my spouse (if any), and on behalf of our minor child, I release, discharge, defend, and hold This Generation Ministries and Faith Harbor Fellowship and their officers, directors, employees, and volunteers, harmless from and against any and all claims, expenses, and any other liabilities related in any way to injuries or other losses sustained by my child as he/she attends, participates in, and travels to and from the activities and facilities of Faith Harbor Fellowship.

Model Release: I understand that this event will have audio and video recording, and photography and I consent to allow This Generation Ministries and Seed Media to use the media captured for their own purposes, including (but not limited to) event promotions and social media posts.

*Important*

Clicking the submit button below will send us your registration. If you are able to prepay for this event and want to be eligible for a free tee-shirt, you will have that opportunity after submitting this form.

Thank you!

DESTINY!

One Word, One Focus!

Since 2000, this unique winter camp has brought clarity to hundreds of youth through a consist impartation of hearing the voice of God and finding your Destiny Road!

Empowering a generation to get on that God appointed path and skip the “waisted years” is a goal we are reaching each year.

Snow hockey, sledding, dog mushing, hiking, and exploring glaciers are some of the activities at Winter Xtreme.

Relevant Workshops, Live Band Worship and Powerful nightly encounters with God make this winter camp that teens will return to year after year.

Winter Xtreme will take place in Valdez, at Faith Harbor Fellowship. To learn more about this location, visit FaithHarborFellowship.com

No Refunds Policy:
TGM is does not refund registration for camps, conferences, concerts or any event we provide. These events take a tremendous financial investment and these event costs are utilized prior to a given event. We are sorry if this inconveniences any of our participants.