Students Under 18 LTC Student Registration Form Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Page 1 Lead THE Cause | Presented by Dare 2 Share in partnership with Sonlife and Colorado Christian University | 866.448.0270 To be completed by the student and student's parent or guardian. Church/Group City AttendingChicago, ILAustin, TXDenver, COWashington, DC Name of Church/Group:Please select... Becker Baptist Bell Avenue Baptist Bennett Christian Fellowship Bethel United Methodist Church Ellendale Boundless Grace Baptist Church Calvary Baptist Church Cedar Rapids Calvary Baptist Church Morrilton Calvary Bible Church Kalamazoo Calvary Church New Prague Calvary Community Church Schaumburg Canyon Creek Baptist Church Cedar Hills Community Church Central Baptist Church Lindale Christ Community Church Beatrice City Hill Church Community Bible Church Omaha Community Fellowship Church Jonesboro Cornerstone Baptist Church Roseville Countryside Christian Church Crossroads Church of Aspen Crossroads Youth Works Desoto Youth Ministries East White Oak Bible Church Faith Baptist Church Amherst Faith Baptist Church Parker Faith Bible Church Cedar Rapids Faith Bible Church Mechanicsville Faith Church Kent Faith Community Church Pipestone Faith Temple Church Family in Christ Community Church Firestorm Drama First Alliance Church Erie First Baptist Church Hiawasse First Baptist Church Hiawatha First Baptist Church Kearney First Baptist Church of Vassar First Baptist Church Pflugerville First Baptist Church Willard First Evangelical Free Church Minneapolis First Free Will Baptist First Presbyterian Church Fairfield First United Methodist Church Collingswood First United Methodist Church Scott City Forcey Bible Church Grace Chapel Castle Rock Grace Church Eden Prairie Grace Community Church Warwick Grace Evangelical Free Church Colville Grace Fellowship Church Timonium Grace for Life Bible Church Grace United Methodist Church Graham Church Green Ridge Baptist Church Harvest Church New Hampton Hattieville Baptist Church Heartland Community Church Heritage Church Visalia Heritage Fellowship Church Leesburg Highline Church Hillside Church Holly Springs Baptist Church ICF Switzerland Immanuel Baptist Church Kenosha Immanuel Church Gurnee Joshua Project Lake Gregory Community Church Laurel Glen Bible Church LFJ Ministry Lighthouse Presbyterian Church Livermore Baptist Church Majestic View Church Maugansville Bible Brethren Church Maywood Evangelical Free Church McLean Bible Church McLean Korean Presbyterian Church Meadow Heights Baptist Church Merrill Bible Church Midland Evangelical Free Church Ministry Partner Monett Community Church Morgantown Community Church Mount Olivet United Methodist Church Mountain View Community Church Nappanee Missionary Church Needmore Bible Church New Heights Church Berea New Heights Church Indianola New Life Church Taylorsville Newbridge Church Northern Heights Baptist Church O'Fallon First United Methodist Church Palmer Ridge Church Parkway Baptist Church Real Life Community Church Redeemer Community Church Refton Brethren In Christ Reston Bible Church River City Community Church Riverside Baptist Church Riverside Evangelical Free Church Round Hill Baptist Church Salem Baptist Church Scofield Church Second Baptist Church Bowling Green Second Union Church Shiloh Baptist Church Southside Baptist Church Southwest Christian High School Syracuse United Methodist Church Thanksgiving Church The Fellowship - Katy The Log Church The Salvation Army - Royal Oak Corps Trinity Church of the Nazarene Trinity Lutheran Church Victory Christian Center Walkowiak Wanette First Baptist West Houston Chinese Church West Pines Baptist Church Woodlands Church Word of Faith Church Zion Evangelical Free Church Group Leader Name: Leader's Email Your Information First Name: Last Name: Address City CountryPlease select... United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau ProvincesPlease select... Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon State/Province Postal Code Email Cell Phone Gender:FemaleMale Date of Birth: Grade Entering: Please select... 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade College freshman Physical Limitations: Dietary Restrictions: Gluten FreeDairy FreeVegeterianOther Other Dietary Restrctions Allergies (or anything that may hinder participation in activities): Rooming Assignment: List your preferred roommate. Leave blank for no preference. Emergency Contact Information Parent/Guardian Name: Relationship: Cell/Main Phone: Other Phone: Other Adult Name: Relationship: Cell/Main Phone: Other Phone: Page 2 Waivers and Releases Below are waivers and releases required for attendance at LTC. Both the parent and student must sign at the end. 1) Waiver and Release I give permission for my child, to attend and participate in activities of Lead THE Cause University (LTC), a program of Dare 2 Share Ministries (D2S) in partnership with Sonlife and Colorado Christian University. I understand that these activities may include physical activities, and may require transportation. I hereby give consent for my child to participate in said activities. Parent's Initial: 2) General and Complete Release In consideration of my child being allowed to participate in activities of LTC, I do, for myself and on behalf of my child, release, forever discharge, and agree to hold harmless Dare 2 Share, its leaders, staff, employees, members, agents, vehicle owners, vehicle drivers, trip sponsors, partners, board of trustees, and any other parties volunteering on behalf of Dare 2 Share, for any and all liability, claims, damages, suits, fees, and costs incurred by the undersigned and the child that occur while the child is at LTC participating in any activity of LTC. Parent's Initial: I realize that my child may incur personal injury or bodily damage while participating in such activities and acknowledge that many activities will be physical in nature and will include travel. I, on behalf of my child, hereby assume all risk of personal injury, sickness, death, damage, and expenses as a result of participating in all activities involved therein. I acknowledge that Dare 2 Share, its leaders, staff, employees, members, agents, vehicle owners, vehicle drivers, trip sponsors, partners, board of trustees, and any other parties volunteering on behalf of Dare 2 Share, shall be held harmless from any and all actions, claims, costs, expenses, and damages of any kind, growing out of or related to any activity of LTC in which my child participates. I further acknowledge that this is a full and complete release of all injuries, sickness, death, limitations, and damages my child could sustain as a result of his/her/their participation in any LTC activities. Parent's Initial: I further agree to hold harmless and indemnify Dare 2 Share, its leaders, staff, employees, members, agents, vehicle owners, vehicle drivers, trip sponsors, partners board of trustees, and any other parties volunteering on behalf of Dare 2 Share for any and all liability sustained by the church, Dare 2 Share equipment, vendor equipment, and campus as a result of the negligent, willful or intentional acts of my child, including expenses incurred. Parent's Initial: 3) Medical Release and Consent for Emergency Medical Treatment I authorize my church group leaders, LTC staff, or facility medical personnel, in whose care my child has been entrusted, to consent to any X-Ray examination, diagnosis and/or treatment (i.e. anesthetic, medical, surgical, or dental), or hospital care to be rendered to my child under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether diagnosis or treatment is rendered at the office of physician or the hospital, I shall be liable and agree to pay all costs and expenses incurred in connection with such medical/dental services rendered. This authority is granted only after a reasonable attempt has been made to contact me or in a life-threatening situation. Parent's Initial: 4) Transportation Release and Waiver I give permission for my child to be transported to and from LTC activities in Dare 2 Share approved transportation (i.e. rental buses). I realize there are some dangers involved in transporting children to their activities; therefore, I specifically waive any claims I may otherwise have against Dare 2 Share, its leaders, staff, employees, members, agents, vehicle owners, vehicle drivers, trip sponsors, partners board of trustees, and any other parties volunteering on behalf of Dare 2 Share. Should it be necessary for my child to return home due to medical reasons, misconduct or otherwise, I shall assume all transportation costs. Parent's Initial: 5) Discipline Release and Authorization to Return Child(ren) In the event of inappropriate conduct by my child, I authorize the group leader or staff to send my child home at my expense from any LTC events/activities. Parent's Initial: 6) Personal Belongings Release I realize that Dare 2 Share are not responsible for my child’s personal belongings or lost or stolen items. Parent's Initial: 7) Electronic and Photo/Video Release I give permission to have my child’s photograph/video taken by Dare 2 Share and its partners at any LTC event and to use the photo/video for any of the following, but not limited to the following: appearance in a video/digital picture to be used in a multimedia presentation or an Internet web page and/or appearance in a picture/video to be used in a publication. Parent's Initial: Moody Bible Institute - Rules and Key Fines The following information applies to campus rules at Moody Bible Institute (MBI). Please be respectful of all MBI property.Rooms must be secured at all times. MBI is not responsible for any personal items or belongings stolen from your assigned room or anywhere on the premises of Moody Bible Institute.All of the floors are gender specific. MBI is providing housing accommodations to other outside groups. Therefore, we ask you to not visit other floors outside of your group and floors of the opposite gender.Alcohol, tobacco, and illegal substances are not allowed on campus.There are no established quiet hours. However, keep in mind this is a community and all noise and/or activity affects others. PLEASE BE CONSIDERATE OF OTHERS.Candles, incense, or any cooking appliances may not be used in your room.Please return your keys in the envelopes provided when you first checked-in. Please use the key return boxes in the lobby of the residence hall unless otherwise instructed. Loss of keys will result in a replacement fee of $15.00 for one key and $25.00 for the set.You must wear and display your conference ID at all times when on campus. Participant's Initial: Huston-Tillotson University - Rules and Key Fines The following information applies to campus rules at Huston-Tillotson University (HT). Please be respectful of all HT property.Rooms must be secured at all times. HT is not responsible for any personal items or belongings stolen from your assigned room or anywhere on the premises of Huston-Tillotson University.The buildings are gender specific. HT is providing housing accommodations to other outside groups. Therefore, we ask you to not visit other floors outside of your group and the building of the opposite gender.Alcohol, tobacco, and illegal substances are not allowed on campus.There are no established quiet hours. However, keep in mind this is a community and all noise and/or activity affects others. PLEASE BE CONSIDERATE OF OTHERS.Candles, incense, or any cooking appliances may not be used in your room.You will be assigned a key with a code that is recorded and specific to your use only. If the key assigned to you is not returned at the end of your stay, a fine will be assessed.You must wear and display your conference ID at all times when on campus. Participant's Initial: CCU Summer Conferencing - Rules and Key Fines The following information applies to campus rules at Colorado Christian University (CCU). Please be respectful of all CCU property. You will be charged the cost to repair or replace any property you damage while on campus. Do not move furniture or bunk/unbunk beds.Do not move any items from one unit to another or from one room to another. All items are inventoried by room and on a master inventory list.Rooms must be secured at all times, do not trip the deadbolt to leave the door unlocked.If you choose to have your doors and/or windows open you must turn off the air-conditioning.Alcohol, tobacco, illegal substances and profanity are not allowed on campus.The pond is not CCU property and it is considered trespassing to enter it. Stay out of the pond.By city ordinance quiet hours begin at 10:00. Please be indoors by that time or be very quiet if outdoors.There is a stove/oven unit in your apartment. It is not for your use if you are under the age of 21. Feel free to use the refrigerator.Candles and other open flame devices are prohibited in the apartments at all times.You will be assigned a key with a code that is recorded and specific to your use only. If the key assigned to you and it is not returned at the end of your stay, a fine of $100.00 will be assessed. Participant's Initial: McLean Bible Church - Rules and Key Fines The following information applies to campus rules at McLean Bible Church (MBC). Please be respectful of all MBC property.Sleeping accommodations will be at a local hotel. Rooms must be secured at all times. D2S is not responsible for any personal items or belongings stolen from your assigned room or anywhere on the premises of McLean Bible Church.Alcohol, tobacco, and illegal substances are not allowed on MBC campus.There are no established quiet hours. However, keep in mind this is a hotel and all noise and/or activity affects others. PLEASE BE CONSIDERATE OF OTHERS.You will be assigned a key to your hotel room. Please try to not lose it to help out the hotel staff.You must wear and display your conference ID at all times when on campus. Participant's Initial: Conducts and Agreements Below are listed guidelines and agreements that Dare 2 Share will require of each participant of Lead THE Cause (LTC). Please carefully read through each section. By signing below, you signify that you are in agreement and will comply to the below. Statement of Faith We believe:…in the Bible, the inspired Word of God, without errors on every matter it touches. Scripture is the supreme and final authority in faith and life. (2 Peter 1:20-21, 2 Timothy 3:16-17)…in one God, eternally existing in three Persons: the Father, the Son, and the Holy Spirit. (Deuteronomy 6:4, Galatians 1:1, Ephesians 4:6, Romans 9:5, Colossians 2:9, John 1:1, Acts 5:3-4)…in the deity of our Lord Jesus Christ, His virgin birth, sinless life, miracles, vicarious and atoning death through His shed blood, in His bodily resurrection, and in His ascension to the right hand of the Father. (Isaiah 7:14, Matthew 1:23, I Timothy 3:16, John 1:14, Philippians 2:6)…in the depravity of humanity. Although man was created in God’s image, because of sin he was alienated from God. As a result, every baby is born with a predisposition toward sin and selfishness. By God’s perfect standard, all fall short of God’s glory and the result is separation from God’s holy presence. (Genesis 1:26-27; Genesis 3:1-7; Isaiah 64:6; Romans 3:10-23; Romans 6:23; Revelation 21:27)…in salvation through faith in Christ alone based on His death, burial and resurrection from the dead. This salvation is a free gift made available through faith in Christ, not through trying harder, making spiritual commitments or doing good deeds. This reconciliation to God through faith in Jesus Christ results in a personal, permanent relationship with God that can never be broken by us and will never be broken by Him.. (Acts 16:31, I Corinthians 15:3-4, Romans 10:9, Ephesians 2:8-10; John 6:37-39; John 10:28; 1 John 5:13;) …in the eternal life of the saved and the eternal punishment of the lost. (John 6:47, John 10:10, Revelations 22:5)…in the imminent return of Jesus Christ. He will come again to the earth in power and glory – both personally and visibly – to consummate history and establish his kingdom firmly and fully on the earth. (Matthew 24:29-31; 1 Corinthians 15:24-28; Revelation 19:11-21:4) Participant's Initial: Code of Conduct "Your attitude should be the same as that of Christ Jesus" Philippians 2:5 While at LTC you will be around campus personnel, other groups sharing the campus and serving in the local community. We need to be above reproach in our attitudes and actions to be sure that we are reflecting the character of Jesus at all times. Our responsibility is to be a positive example to others on and off site. Therefore:No alcohol, chewing tobacco, drugs, etc. No guys and girls in each other's rooms or inappropriate interaction with team members of the opposite sex. No bad attitudes, cursing, coarse words etc. No inappropriate entertainment activities, movies, places, attire, etc. Any questions on what is appropriate in the Code of Conduct can be directed to the LTC Event Director. At Dare 2 Share our driving principal is: We strive to do the right thing in the right way for the right reasons as we minister to one another. Participant's Initial: Technology Media Code of Conduct Dare 2 Share Ministries allow the use of technology medium (e.g. cell phones, smart phones, laptops, social media, and other similar communication technology) during LTC. Technology and social media is a lifestyle in our current day and generation. The LTC program will have key elements where technology will be useful in the training. However, we will uphold integrity and a conduct that is appropriate as a follower of Christ in the use of outward communication. I will use my technological medium that is fitting to the program and for emergency purposes.My communication using technology and social media will be done with integrity, truth, and in a manner that is appropriate for a Christ follower.I will focus on the training when required and set aside my technology and the use of it when not required so that I can gain as much from the program as I can. Participant's Initial: Driving Agreement Due to high risk and liability, any participant with a car and/or of driving age will be required to refrain from the personal use of their or any other vehicle throughout the LTC program and stay. Participants understand that travel to and from locations involving the program will be provided by Dare 2 Share Ministries. Participant's Initial: To the best of my knowledge all information provided is correct, accurate, and complete. By entering my name below, I acknowledge that I have read and agree to all the above provisions: Parent Signature: Date: Student Signature: Date: Captcha Please enter the characters you see in this picture: Characters This helps prevent automated form submissions. If you are not sure what the characters are, make your best guess. You will have another try in the next screen.Can't see the image? Click here for an audible version in English. Save my progress and resume later | Resume a previously saved form Need assistance with this form?