MYM IMPACT REGISTRATION FORM 2021

Please fill out this form, choose your payment and click submit (ONCE ONLY). You will get a confirmation email of your submission.

MYM IMPACT at Lipscomb University
JUNE 21-23, 2021
6th-12th grades

TRANSPORTATION BY MAYFAIR BUS -
Parent Drop-Off at Mayfair - Monday, June 21st at 6:30am
Parent Pickup at Mayfair - Wednesday, June 23rd at 11:00pm

Questions/Problems? Contact Nancy at (256)682-8208 or nancy@mayfair.org.
 
 
 
 
 
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LODGING:

Hampton Inn & Suites 
5630 Franklin Pike Circle, Brentwood, TN
 
BREAKFAST WILL BE AVAILABLE AT THE HAMPTON INN EACH MORNING, LUNCH AND SUPPER WILL BE SERVED AT LIPSCOMB UNIVERSITY DURING THE EVENT EACH DAY

 
EMERGENCY CONTACT

 
 
 
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BEHAVIOR POLICY/PARENTAL CONSENT/MEDICAL RELEASE

By registering for this event, I agree to abide by the expectations set up by the MYM Leadership Team and will strive with a Chirstlike attitude to do everything within my power to make this camp a great experience for myself and all those who attend. I understand that this camp will abide by covid-19 regulations provided for camps and that by signing up to attend, I agree to abide by the safety measures put in place for this camp. 
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PARENTS - Medical and Liability Release with Lipscomb University
I hereby authorize my group's chaperones, the director of IMPACT, Lipscomb University medical personnel or their designees to make any emergency healthcare decisions and to authorize or arrange for emergency medical treatment, if necessary, with any hospital, physician or other healthcare provider which shall be deemed necessary under the circumstances, according to his/her best judgment and to give the medicaitons indicated on this form as deeemed medically needed to my son/daughter.

I hereby release Lipscomb University, it's trustees, officers, employees, agents (the "Releasees"), from any and all liability for sickness, accidents or injuries of any nature or cause whatsoever to my child or me, other than due to gross negligence or intentional fault of the Releasees, while attending, traveling to or from IMPACT. 
By typing my name in the box below, I am giving my electronic signature to the Medical and Liability Release Information above. 
 
 
COST OF IMPACT IS $185 AND INCLUDES LODGING, ENTRANCE TO IMPACT AND MEALS REFERENCED ABOVE DURING THIS EVENT. YOU MAY CHOOSE TO PAY BY PAYPAL OR BY CHECK BELOW:

 

Description

Please fill out this form, choose your payment and click submit (ONCE ONLY). You will get a confirmation email of your submission.

MYM IMPACT at Lipscomb University
JUNE 21-23, 2021
6th-12th grades

TRANSPORTATION BY MAYFAIR BUS -
Parent Drop-Off at Mayfair - Monday, June 21st at 6:30am
Parent Pickup at Mayfair - Wednesday, June 23rd at 11:00pm

Questions/Problems? Contact Nancy at (256)682-8208 or nancy@mayfair.org.