I N D I A N A W E S L E YA N U N I V E R S I T Y
HIGH SCHOOL YOUTH CONFERENCE
SCHEDULE OF EVENTS
INDIANA WESLEYAN UNIVERSITY FUSION 2016
VOLUNTARY RELEASE FROM LIABILITY AND ASSUMPTION OF RISKS (“Release”)
IMPORTANT NOTICE: BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE
INDIANA WESLEYAN UNIVERSITY (IWU). PLEASE READ CAREFULLY.
Name of Participant (please print): ________________________________________ Date of Birth: ____/____/_____
Phone Number: ____________________________
Emergency Contact: _____________________________________________ Relationship: ____________________
Phone Number: ____________________________
DISCLAIMER
Indiana Wesleyan University, its officers, directors, employees, volunteers, members and representatives (hereafter referred to as “the University”) are not responsible for
any injury, loss, or damage sustained by any person, which may result from or be related to participating in FUSION 2016 and all associated activities (hereafter referred
to as “Activities”), irrespective of the cause of such injury and whether such cause is alleged to be the fault of the University. Such Activities include, but are not limited to
swimming, diving, artificial climbing wall, inflatable games, walley-ball, soccer, basketball, dodgeball, racquetball, carpetball, running, jumping, sliding, walking and use
of related equipment.
ASSUMPTION OF RISKS
In consideration of my participation in these Activities, I acknowledge that I am aware of the risks of harm to myself and my property, both from
known risks and unanticipated risks, while participating in or traveling to or from the Activities. I participate in the Activities willingly, voluntarily and
in reliance, not upon the property, equipment, facilities and existing conditions furnished by the University or others, but upon my own judgment
and ability, and I thereby assume all risk of loss, damage or injury (including death) to myself and my property from any cause whatsoever and
whether or not attributable to the negligence of others.
5 - 7:30 p.m.
Registration in Maxwell Center
7:15 p.m.
Doors open: Pre-Rally
8 - 10:30 p.m.
FUSION Friday Night with NEEDTOBREATHE
10:30 p.m. -12:30 a.m.
Late Night Options: open gym, dodgeball, climbing wall,
sports tournaments and McConn Coffee Co.
12:30 - 1:45 a.m.
Pizza Party
2 a.m.
Curfew: In rooms
INITIALS
Saturday, APRIL 2
8 - 9:30 a.m. Breakfast
In return for the University allowing me to voluntarily participate in these Activities, I agree:
1. TO FOREVER RELEASE, ACQUIT AND FOREVER
2. TO BE SOLELY RESPONSIBLE FOR ANY INJURY,
DISCHARGE AND RELEASE THE UNIVERSITY, AND
LOSS, OR DAMAGE which I might sustain while
TO ASSUME AND ACCEPT ALL RISKS arising out
participating in the Activities, even though such
of, associated with or related to my participating
injury, loss, or damage may have been alleged to
in the Activities, even though such risks may
have been caused by the actions of the University,
be alleged to have been caused by the actions,
including, but not limited to, negligence.
including negligence, of the University.
3. TO INDEMNIFY AND HOLD THE UNIVERSITY
FREE AND HARMLESS from any claims, actions,
causes of actions or demands of any kind asserted
by the undersigned or by any third parties for
any injuries or damages which may arise from
participating in the Activities.
INITIALS
INITIALS
PARTICIPANT DECLARATIONS
INITIALS
9:30 - 10:30 a.m.
Rally with Antwaan Randle El and the Jordan Brown Band
10:45 - 11:30 a.m.
Seminars
11:30 a.m. - 1 p.m.
INITIALS
I affirm that I have the requisite skills and abilities to safely participate in the Activities. I do hereby declare myself to be physically and mentally sound and suffering from
no condition, impairment, disease or other illness that would prevent or inhibit my participation in these Activities. Any equipment I supply is in good condition, order,
and repair, and is fit for and will be used for its intended purpose. If I believe that a materially unsafe condition exists, I will report the condition to an official, and cease
participation in the activity until that condition is resolved. I certify that I have adequate insurance to cover injury or damage, including damage to or loss of personal items,
that I may cause or suffer while participating in these Activities, or else I agree to bear the cost of such injury, damage or loss myself. I further certify that I am willing to
assume the risk of any medical or physical condition I may have. I consent to the provision of emergency medical treatment to the extent that the treatment is necessary in
the opinion of a medical professional.
ACKNOWLEDGMENT
I acknowledge that I have read this agreement, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, executors,
administrators and representatives in the event of my death or incapacity.
In consideration that the participant is a Minor, this Release remains in full force and effect and that by signing this Release, I affirm that I am the legal guardian of the Minor
and agree and consent to this Release on behalf of said Minor.
Signature of Participant (if 18 years of age or over)___________________________________________ Date_____________________________
Printed Name of Guardian/Parent (if Participant is under 18 years of age)___________________________________________________________
Signature of Guardian/Parent (if Participant is under 18 years of age)______________________________________________________________
Lunch
1:15 - 2 p.m. Seminars
Youth Leader/Sponsor Seminar
2 - 2:30 p.m.
Game Show
2:30 - 4 p.m. Activities
4 - 5:30 p.m.
Rally with Antwaan Randle El and Jordan Brown Band
5:30 p.m.(Optional) Dinner
*Schedule subject to change
S TU DE NT M I NIS T R IE S
4 2 0 1 SO U TH WA S HI N G TON S TRE E T
M A RI ON , IN D I A N A 4 6 9 5 3 - 4 974
I N DWE S. E D U
INDEMNIFICATION AND RELEASE OF LIABILITY
O
I
S
U
F
#
INITIALS
N
E
E
T
X
I
NS
These Activities involves inherent risks. These risks could result in bodily injury including burns, slips and falls, injury to muscles and joints, broken
bones, head or neck injuries, lost wages, loss of services, emotional distress, sickness, drowning, disease, dismemberment, death and any other
foreseen or unforeseen damages.
FRIday, APRIL 1
N E E DTO B R E AT H E
AsPt RILnd
1 2
2 016
and
With Antwaan Randle El, one of the NFL’s most electric players ever, expect the unexpected.
Antwaan was coached in college by basketball legend Bobby Knight, drafted out of high
school by the Chicago Cubs, and threw a Super Bowl touchdown pass - as a wide receiver.
He excelled at every level of athletic competition.
Antwaan’s passion for his community shines through today in all he does. He is the founder
of the El Foundation. The El Foundation consistently provides and implements enrichment
and recreational programs, camps and opportunities to support, encourage, develop and
empower exceptional and successful young men and women.
Now he is a speaker, a broadcaster, an educator, a leader. With Antwaan Randle El, expect
the unexpected.
Worship: Jordan Nicole Brown
Jordan Nicole Brown is a full-time worship leader at College Wesleyan Church in Marion,
Indiana. She loves the conversation of worship and getting to work with a large variety of
volunteers on a weekly basis. Creativity through scripture, art and music in a worship service
is one of her biggest passions.
More than a college visit,
Fusion is a campus
movement dedicated
to providing space for
high school students
(grades 9 -12) to grow
closer to God. Fusion
2016 is a worship
experience designed
to help students come
and experience the
love of Christ, sense His
power at work, and begin
a life transformed.
#FUSIONSIXTEEN
2016 REGISTRATION
Q AND A
Speaker: Antwaan Randle El
ALSO AVAILABLE ONLINE AT INDWES.EDU/STUDENTMINISTRIES
WHO IS FUSION DESIGNED FOR?
High school students in grades 9 through 12.
THIS REGISTRATION IS FOR: o Student
o Adult Sponsor
Male
Name__________________________________________________________________________ o
WHAT DOES THE WEEKEND COST?
Only $55 for students and sponsors.
*Sponsors are needed for both male and female students. There must be one male sponsor
for every 10 male students and one female sponsor for every 10 female students.
City______________________________________________State______________ Zip__________________________
Phone ( ____________ ) ______________________________________________________________________________
E-mail______________________________________________________________________________________________
High School________________________________________ Graduation Year ___________________________________
WHERE WILL I STAY?
The choice is yours. Students and sponsors may stay with IWU student hosts in residence
halls. Please note that not everyone will have a bed. Remember to bring a sleeping bag and
pillow. You can also make your own arrangements to stay in an area hotel. Sponsors must
remain with their students in either campus housing or at a hotel.
Church/Group_______________________________________________________________________________________
Nickname___________________________________________________________________________________________
(please provide or create a name that will help us identify your group, e.g., Surge, United, The Well)
Contact Person_______________________________________________________________________________________
Daytime/Work (
Jordan is an alumnus of Indiana Wesleyan University and no stranger to FUSION. Over the
past two years, she has been writing and recording her newest EP titled “Underneath.” It is
now available for free on NoiseTrade.
WHAT ABOUT SEMINARS?
A wide variety of seminars with topics relevant to teens and leaders.
GROUP OVERNIGHT HOUSING PLANS (CHECK ONE)
In Concert: NEEDTOBREATHE
WHO CAN ATTEND THE FRIDAY NIGHT RALLY WITH NEEDTOBREATHE?
Everyone! Tickets can be purchased at the IWU Box Office or iTickets.com. (The Friday Night Rally is included in the FUSION registration fee.)
With the Rinehart brothers, sons of a pastor who hail from the rural town of Possum
Kingdom, as the songwriting core of the band, NEEDTOBREATHE has built a successful
career, earning a sizeable fanbase with their extensive touring.
“We had a few goals as a band for the album,” Bear says. “I had them written in my
notebook while I was writing songs. They were really basic: Keep it simple, not too many
instruments, and have fun with it. And the last one was: be ourselves.”
“We’ve come through some rough moments and some amazing moments,” Bo says. “We’re
the most energized we’ve ever been. The band is young again. We’ve got a new sense of
purpose and we believe in what we’re doing and are completely honored and humbled that
there are fans out there who appreciate that and love the music along with us.”
oFemale
Address____________________________________________________________________________________________
WHAT ABOUT MEALS?
All meals are included in the registration cost and will be served in Baldwin Dining Hall.
Rivers In The Wasteland, NEEDTOBREATHE’s latest album, opens a new chapter in the
Grammy-nominated, South Carolina-based rock band’s story. But the band, comprised of
brothers Bear and Bo Rinehart, Seth Bolt, and Josh Lovelace, couldn’t have arrived here
without the tumultuous narrative that came before, each aspect of their career building up
to this point.
(CHECK ONE)
)____________________________________ Mobile (
)__________________________________
E-mail_____________________________________________________________________________________________
ON CAMPUS
(Students and sponsors stay with IWU student hosts in residence halls. Remember to bring a sleeping bag and pillow, as not
everyone will have a bed.)
o IWU to make arrangements
o We will make own arrangements with an IWU student
Name of host student________________________________________
OFF CAMPUS
o Other/Area Hotel (Sponsor must make own arrangements for group. See website for listings.)
PLEASE NOTE
WHAT SHOULD I BRING?
•
•
•
•
•
•
•
Sleeping Bag & Pillow
Bible
Personal Items
Towel
Gym Shoes
Alarm Clock
Signed Release Form
ACTIVITIES
•
•
•
•
•
•
•
Inflatables
Walley-Ball
Soccer
3-on-3 Basketball
Dodgeball
Board Games
Ping Pong
•
•
•
•
•
•
•
Foosball
Carpet-Ball
Globe Theatre Movie
McConn Coffee Co.
Climbing Wall
Game Show with Prizes
...and more
* subject to change
• STUDENTS MUST BE ACCOMPANIED BY AN ADULT SPONSOR. There must be one male sponsor for every 10 male students and one
female sponsor for every 10 female students.
• Please copy this form, as needed, for additional registrations. Submit registrations as a group.
Online registrations are preferred.
• Groups must submit forms together to be housed together. All housing assignments will be final on
March 29, 2016.
• Cost is $55 per registration. Please make individual checks payable to your Church/Organization.
Group Leaders will submit one final payment for the group to Indiana Wesleyan University.
• March 21, 2016 is the registration deadline. Space is limited. Registration deadline is subject to change based upon availability.
S T U D ENT MINIS T RIES
4201 S OUTH WAS HINGTON S TRE E T
MARION, IND IANA 46953-4974
IND WE S.E D U
QUESTIONS? 866-468-6498 EXT. 6507 / 765-677-6507 / STUDENT.MINISTRIES@INDWES.EDU
THE RELEASE OF LIABILITY FORM ON THE REVERSE SIDE MUST BE COMPLETED