FALL RETREAT 2024 REGISTRATION

Parent Name

This address will receive a confirmation email

Phone

Address

Student 1 Info

Student Name

Grade

6th 7th 8th 9th 10th 11th 12th Adult Leader

Shirt Size

Activity Choice (choose 1)

Paintball Horseback Riding Ropes Course & Giant Swing

Allergies

Student 2 Info

Student Name

Grade 6th 7th 8th 9th 10th 11th 12th Adult Leader

Shirt Size

Activity Choice (choose 1) Paintball Horseback Riding Ropes Course & Giant Swing

Allergies

Student 3 Info

Student Name

Grade 6th 7th 8th 9th 10th 11th 12th Adult Leader

Shirt Size

Activity Choice (choose 1) Paintball Horseback Riding Ropes Course & Giant Swing

Allergies

Student 4 Info

Student Name

Grade 6th 7th 8th 9th 10th 11th 12th Adult Leader

Shirt Size

Activity Choice (choose 1) Paintball Horseback Riding Ropes Course & Giant Swing

Allergies

Waivers

I, the undersigned, certify that I am the parent or legal guardian of the above named student(s) (hereafter the “minor child(ren)”). I hereby give my consent to have my minor child(ren) participate in this activity of Berean Bible Church. I hereby give my minor child(ren) permission to ride in the vehicle of a volunteer or chaperone designated by a Berean Bible Church staff member or volunteer or a church-owned vehicle with a Berean Bible Church approved driver. I acknowledge that no profanity, weapons, smoking, vaping, alcohol, or drugs are allowed in church or volunteer vehicles. By signing this waiver, I assume the risk of my minor child(ren) contracting COVID-19 as a result of the participation of my child(ren) in this activity. Under Georgia law, there is no liability for an injury or death of an individual if such injury or death results from the inherent risks of contracting COVID-19.

I agree

To the fullest extent permitted by law, I release Berean Bible Church, its trustees, officers, directions, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child(ren) while participating in the activity and agree to save and hold harmless Berean Bible Church, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child(ren)’s participation in the activity. Further, being the parent or legal guardian of the minor child(ren), I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor child(ren). I understand that efforts will be made to contact me prior to treatment but, in the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child(ren). As parent or legal guardian, I understand that I am responsible for the health care decisions of my minor child(ren) and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given to my minor child(ren). Any insurance policy of the church or organization sponsoring this event will be used as the secondary coverage.

I Agree

Payment

Cost: $150 per student.

***Earlybird Discount: Register & pay by Wed, Oct 9th to receive $10 off per student!

Select the number of students you are registering from the dropdown:

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

FALL RETREAT 2024 REGISTRATION

Description

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