The United Methodist Church

UNITED METHODIST YOUTH FELLOWSHIP IN THE PHILIPPINES

Northwest Philippines Annual Conference
ILOCOS SOUTH DISTRICT

AGREEMENT FORM
Delegate Information

Full Name of Child/Delegate (First/Middle/Last): _______________________________________________________

Local Church: ________________________________ Contact #: ________________________

Date of Birth (mm/dd/yyyy): ___/___/____ Gender: ________ Age: ____

Grade/Year in School: _____________ School: ________________________________________________________

Health Issues/Allergies/Activity Restrictions/Medications: _______________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

ACCEPTANCE OF RESPONSIBILITY

In consideration of our Church’s approval for my participation in the Summer Institute 2019, I agree to the following
(please write your initials in the bracket ( ) after each paragraph to confirm that you have read it):

1. To obtain an Endorsement Letter, signed by our Administrative Pastor, Deaconess, Youth Coordinator/s, Church
Council Chairperson, for the approval of my endorsement as an official delegate of this year’s Summer Institute.
( )
2. That, during the period of my participation in the Institute I will also be subject to the policies and regulations in
effect at Brgy. San Jose. ( )
3. I understand that participation in the Institute is an opportunity to enable me to broaden my learning and
acquire new knowledge, to create/build stronger ties with my co-UMYF, to understand and learn more about
our faith and beliefs, and to know Christ more and make Him known. ( )
4. That, at the end of my participation in the Institute I am responsible for continuing what I have learned at my
home Church and applying it in my daily life. ( )
5. Upon my return to my Home Church, to submit the appropriate report summarizing the things I have learned to
the Congregation. ( )

I HAVE READ AND UNDERSTOOD AND INTEND TO BE BOUND BY THIS AGREEMENT IN ITS ENTIRETY AND I AM AWARE
THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN,
EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES. I EXECUTE
THIS AGREEMENT VOLUNTARILY.

Signed: Noted by: (Parent)

______________________________ ______________________________
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME
 The United Methodist Church
UNITED METHODIST YOUTH FELLOWSHIP IN THE PHILIPPINES
Northwest Philippines Annual Conference
ILOCOS SOUTH DISTRICT

ENDORSEMENT LETTER

To whom it may concern:

This is to notify that ________________________________, a young people of _________________________,

is hereby endorsed to attend the Summer Institute 2019 with the theme “LAKBAYAN: Ang Pagsunod sa mga
Yapak ni Hesus”. By signing this, we certify that he/she is physically, mentally, emotionally, and spiritually fit
to attend this said event.

Signed:

_________________________ _________________________
Administrative Pastor Youth Coordinator

_________________________ _________________________
Deaconess Church Council Chairperson