Youth Conference featuring Dawn Armstrong from Meet the Mormons Movie

Please click here to submit youth SkyZone Waiver 

Please register online below and upload your insurance card

Enter a number between 14 and 99
Enter a number between 8 and 99. Adults type 99.
Medical Information
Please fill out the medical information for the participant.
Does the Particapant have any of the following?
Medications
Explain and list medications

Over-the-counter Medications

I give my consent for my child/self to receive, if needed, the following over-the-counter medication, or their generic equivalent, according to the recommended dosage listed on the medication. Please use the drop down menus for all that apply.
Participant Agreement
Please review the form and read the statement below
I declare that the above medical statements are complete and correct, and agree to act in accordance with the Statement above. Please type your name in the box below.
Parental Permission
Please review the form and read the statements below.
I, the undersigned, am aware that my youth will be participating in the above Stake Youth Conference in Riverside, CA. I have read the Statement of Responsibility and have supplied the medical statements above, which are complete and correct. I hereby give my full permission for him/her to participate in this youth conference and authorize the adult leaders supervising this activity to administer emergency treatment for any accident or illness and to act in my stead in approving necessary medical care. In the event any medical attention is needed, I hereby authorize any physicians in charge of my child to administer such medical or surgical treatment or carry out such procedure as may be deemed necessary or advisable in the diagnosis or treatment of my child. This permission includes travel to and from activities during the conference as well as participation at the conference. Please type your name in the box below.