Vineyard United Student Consent Form

I release all officials and professional personnel from any claim whatsoever on account of first aid, treatment or service rendered to my child during participation in these activities. This release contains the entire agreement between the parties. I give permission to pastoral leaders to secure emergency medical and surgical treatment and to provide routine, non-surgical medical care for the minor child named above while attending the retreat. I understand that if my child develops a fever that continues at 100°F or above, he/she will need to be sent home. The pastoral leaders may deem it proper to send my child home in the event he/she develops certain other illnesses or sustains certain injuries. This will necessitate me coming to Michindoh Conference Center to transport my child home, or to arrange for his/her transport. Further, I understand that a decision to send a child home is not made lightly, and is made with the good of the individual child and other participants in mind.

 

By signing at the end of this application I agree all of the above information is accurate and the terms of this release are contractual and not a mere recital.

ALL MEDICATIONS MUST be in the original package. ALL PRESCRIPTION MEDICATION MUST have the prescription label, including dosage. Please list all medication your student will be taking while at the retreat. Please only send the amount of medication needed for this trip.

Note: There will be a nurse present during the retreat, but all medicine will be administered by the adult leader from the church. The nurse on site is for First Aid purposes only.

Adventure Activities Participant Agreement

• I am voluntarily agreeing to participate in adventure activities (e.g. high ropes, climbing walls, challenge initiatives), and I understand I have the right to limit my participation in any activity that I believe will compromise my safety.

• I understand these activities require minimum levels of fitness, ability, and health (physical, mental, and emotional), and that I am responsible to know my own condition and limitations and should not participate if I suspect my health could be at risk for any reason, or if a pre-existing condition could be aggravated.
• I will not participate if I have any of the following conditions: a recent surgery or illness; heart conditions, high blood pressure, or aneurysms; neck, back, or bone ailments; pregnancy; or under the influence of alcohol, drugs, or medication that impairs my physical, mental, or emotional abilities.
• I understand these activities have significant and inherent risks (e.g. cuts, bruises, dislocations, fractures, or fatality); and that these types of injuries may result from my own actions, from the actions of another participant, or from a combination of both; and that a number of these risks are beyond the control of Michindoh and its staff. I am assuming these risks voluntarily.
• I understand that Michindoh staff has the right to deny my participation and that it is my responsibility to follow the instructions, guidelines, and procedures established by the facilitators. If, at any time, I do not understand or have not heard specific instructions given by the facilitators, I realize it is my responsibility to ask for clarification and/or assistance before participation.

 

Medical Release

• If an illness or injury occurs during my participation, I give my consent to Michindoh employees and to emergency medical personnel to treat me if they deem it to be medically necessary, and to secure such medical advice and services they feel necessary for my well-being including emergency anesthesia and/or surgery.
• I agree to accept financial responsibility for any expenses and/or loss of income not covered by my insurance policy that results from my participation in adventure activities.

 

Liability Release

• I understand and assume all dangers and risks, known and unknown, associated with my presence at any activity or participation in or use of adventure activities, and waive, release, and discharge Michindoh and their agents, officers, and employees from any and all claims or causes of action arising from such presence or participation. I do hereby release Michindoh and its agents, officers, and employees from any and all liability, even if arising from the negligence of the releasees. I do hereby agree to indemnify and hold harmless Michindoh and its agents, officers and employees for any accidents, injury, loss or damage of property, and from any legal fees that I may ever have as a direct or indirect result of said presence or participation. This release, indemnification, and waiver shall be construed broadly to the maximum extent under applicable law.
• My signature on this document is also intended to bind my representatives, administrators, successors, heirs, next of kin, and assigns on my behalf.
  By signing below I am agreeing that I have carefully read and agree to all of the sections above. In the case of the participant being a minor, the signatures below indicate both the minor and the parent/guardian agree to all of the sections above and have discussed the information together.

 

By signing at the end of this application I am agreeing that I have carefully read and agree to all of the sections above. In the case of the participant being a minor, the signatures below indicate both the minor and the parent/guardian agree to all of the sections above and have discussed the information together.

This form is intended to remind participants of the seriousness of participation in adventure activities with a preexisting injury or other known medical condition which might be aggravated during participation or cause harm to others, and to collect basic health history in case of an emergency.

If you answered “Yes” to any question above, it is your responsibility to discuss that item with a medical professional, group leader, and/or Michindoh facilitator in order to make an informed decision about whether or not you should participate. Michindoh facilitators can only provide information regarding the activities to participants and cannot provide suggestions, approval, or advice on whether a participant should participate in light of the kind of information communicated on this form. Michindoh reserves the right to deny or stop participation of any participant at any time.

Event Photography & Media Release

By registering for and attending this event, you are granting permission for photos or video that include your image or likeness to be used by Vineyard Youth Great Lakes and Vineyard USA (VUSA). These images or recordings may appear on websites, social media platforms, printed materials, or any other media formats used to promote or represent Vineyard Youth Great Lakes or Vineyard USA.

Full Release

In consideration of my event registration, I hereby grant to Vineyard Youth Great Lakes and Vineyard USA, including their ministries, affiliates, auxiliaries, licensees, successors, and assigns (collectively, “Vineyard”), the perpetual, worldwide right to photograph, film, and record me in any audio and/or video format (including live streaming).

I understand that Vineyard may use, reproduce, edit, and distribute these recordings or images—whether now known or hereafter developed—in any and all media, for purposes including (but not limited to) promotion, publicity, advertising, or other related uses connected with Vineyard’s ministry and activities.

I acknowledge that all rights, titles, and interests in these materials—including copyright—belong solely to Vineyard, as works made for hire under U.S. copyright law. If for any reason such materials are not considered works made for hire, I hereby irrevocably assign to Vineyard all rights and ownership therein, in perpetuity and throughout the universe.

I expressly release and hold harmless Vineyard Youth Great Lakes, Vineyard, and their agents or representatives from any and all claims of defamation, invasion of privacy, violation of publicity rights, or any other claims arising out of or related to the use, production, or distribution of these materials.

 

By signing at the end of this application I am agreeing that I have carefully read and agree to all of the sections above. In the case of the participant being a minor, the signatures below indicate both the minor and the parent/guardian agree to all of the sections above and have discussed the information together.

The price for Vineyard United increases each month. The price per month is as follows:

 

December $175 (Use coupon code EARLY)

January/February $185

Late Registration $195 (Availability dependent on space)

 

If paying now, you must use the corresponding coupon codes to receive the discounted rates for November and December.

There is a $50 non-refundable fee for cancellations after January 11, 2026. Due to Michindoh Conference Center needing our headcount weeks before our event, we are not able to issue any refunds after January 23, 2026.

If you're having issues registering or have any questions, please email Cassie Berry at cassie@lancastervineyard.org or Jeremy Shelley at jeremy@questvineyard.org.