B2SR19 Registration Form

REGISTRATION FORM

* Indicates required field

Parent Name *

First

Last

Address *

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Line 2

City

State

Zip Code

Country

Parent Phone Number *

Student Name *

First

Last

Student Phone Number *

Student Email *

Grade *

School *

Elevate Student Ministries Liability Waiver

PERMISSION AND TRANSPORTATION
I, ______________________ give permission for my child to participate in and to be driven by the adults leading the activity.

LIABILITY WAIVER
I recognize that certain hazards and dangers are inherent in the events and programs of Emmanuel Baptist Church. I acknowledge that although Emmanuel Baptist Church has taken safety measures to minimize the risk of injury to participants, Emmanuel Baptist Church cannot guarantee that the participants, equipment, premises, and/or activities will be free from hazards, accidents, and/or injuries. In consideration of Emmanuel Baptist Church accepting and permitting my child to participate in this activity, I agree that Emmanuel Baptist Church, a non‐ profit corporation, its agents, officers, employees, trustees, and volunteers will not be liable for any injury, death, damage and/or loss to my child, and/or anyone claiming on my child’s behalf, and I further agree to hold harmless, indemnify and defend Emmanuel Baptist Church, its officers, agents, employees, trustees, and volunteers for and from any and all damage during the activity, whether such injury, illness, or damage occurs on or off the church premises.

PHOTO RELEASE
I certify that photographs or videotape pictures of my child participating in Emmanuel Baptist Church programs may be reproduced and utilized in promotional materials for the Church.

Parent Signature *

First

Last

Submit

*Click submit to go to the Sky Zone website. Please fill out their waiver. Your student will not be able to jump if it is not completed. Once you have submitted the
Sky Zone waiver your registration for our Back 2 School Rally will be complete. Thank you!

REGISTRATION FORM

Elevate Student Ministries Liability Waiver

We Would Love to Have You Visit Soon!

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