DNow Registration

Event Title: Disciple Now
Where is the event begin held: Connie Maxwell & South Main Baptist Church

Parent/Guardian Email

This address will receive a confirmation email

Child Name:

T-shirt Size

Date:

My child has permission to participate in all prescribed activities except as noted by me.

I hereby, remise, release, and forever discharge ABBEVILLE FIRST BAPTIST CHURCH, its agents, servants, and all other persons, firms, and corporations whomsoever of and from any and all actions, claims and demands, whosoever which might happen while on the way to and from or on premises during a Abbeville First Baptist Church Event.

I am over eighteen years of age, and legally competent to execute this medical consent and release; and that before signing this claimant has fully informed himself/herself of its contents and meaning and has executed it with full knowledge thereof.

I give permission for my child to be transported from Abbeville First Baptist Church to the event in question. In the case of any unforeseen accident, I will not hold Abbeville First Baptist Church, or anyone affiliated with Abbeville First Baptist Church liable?

Yes No

Pictures of my child may be taken and used on Abbeville First Baptist Church’s website or media?

Yes No

Has anything changed medically for your child(ren) since our last event? If so, please fill out/update the medical information on the Annual Information & Release Form

Yes No

My child has my permission to participate in this event.

Signature (Parent or Legal Guardian):

Date:

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

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DNow Registration

Description

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