MAX Student 2024

Student Information

Name Of Participant As Appears On Insurance Information

Select the church you attend

Select the church you attend or if you are coming with a friend select the church they attend.

Shirt Size

Name

First Name

Last Name

Birthday

YYYY

Gender

Student Phone

(###)

###

####

Email Address

Entrant Information

Check One

Junior High (Grade 8 or below) Teen Entrant

Senior High (Grade 9 and up) Teen Entrant

Rule: See MAX@MNU Handbook, pg 5-8, for Liberal Arts Requirements, including a maximum if TWO (*) style events. Individual sports or Nightly options listed below are not counted towards this limitation.

Liberal Arts Description

Please write the name of your piece and indicate which category it goes with in the text box below. Separate each piece with a /

Athletics

Individual Sports - Friday-Saturday

Bowling

5K Run

Tennis

Team Sports Friday - Saturday

Select up to one team sport to compete in Friday & Saturday

Thursday Night Options

Select up to one activity to do Thursday Night

Friday Night Option

Exhibition Events

PARENT’S OR GUARDIAN’S WAIVER (Must be completed by all parents and guardians for participants under the age of 18)

I hereby approve the application, certify its correctness and expressly wave any and all claims against the Prairie Lakes Church of the Nazarene NYI, any of its District Boards, and its representatives because of any injury or other damage that may have incurred to my child or his/her property in connection with or incident to or travel to or from the Prairie Lakes NYI MAX and related events. Permission is hereby given for images of retreat experiences that include my child(ren)'s likeness to be used in promotions of retreat activities. IN CASE OF MEDICAL EMERGENCY: I hereby understand that every effort will be made to contact parent or guardian listed. In the event I cannot be contacted, I hereby give permission to the physician selected by the staff to secure proper treatment of my child for and to any injections, hospitalization, anesthesia, or surgery for my child as named on this form.

Parent/Guardian Electronic Signature*

Type name to sign form and agree to the above statement.

First Name

Last Name

Todays Date

YYYY

Thank you submitting part 1 of registration. Go HERE to complete registration with MNU.

Don’t forget to make hotel & travel arrangements with your church!

LINK TO MAX FORM: https://apply.mnu.edu/register/?id=f6ebbdbb-bff3-47f8-94e9-4880612ad212

MAX 2024 Student Registration Form