Youth Xtreme Winter Dec. 27-30, 2024

$50 Deposit due Oct. 23 to reserve your spot!

Xtreme Winter Branson: $200/student with $50 Due Oct. 23; Balance of $150 due Nov. 30.

Join a couple thousand students for an unbelievable conference that includes the best in Christian bands and great Gospel messages. Visit www.xtremeconerences.com for more information.

A 2024 Health/Medical Release Form must be completed or on file for each youth attending. Contact Travis.Dierker@genesiseureka.com if you need the link for Health/Medical Release.

Name of Parent/Guardian *

First

Last

Phone of Parent/Guardian *

Email of Parent/Guardian *

Indicate Youth Name(s) Attending *

Payment Options *

Deposit for 1 youth – $50.00
Full Payment for 1 youth – $200.00
Deposit for 2 youth – $100.00
Full Payment for 2 youth – $400.00
Deposit for 3 youth – $150.00
Full Payment for 3 youth – $600.00

Balance of $150 per student due Nov. 30

Stripe Credit Card *

Online payment optional. Payment by check to Genesis Church also accepted; indicate Xtreme Winter on memo line.

By checking this box, I attest that the information provided is accurate to the best of my knowledge. do hereby release, forever discharge and agree to hold harmless Genesis Church and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the youth-participant that occur while said youth is participating in any trip or activity. *

Electronic Signature Equivalent

“Periodically, pictures of these events will be taken and used for scrapbooks or other publications. You must give written notice to Genesis Church if you do not want your child’s picture included.”