Portal

Event Registration

Back to Event Detail

BKC: Club Suggs Park on Monday, July 9, 2018 @ 6:00 PM

Provide the information below as a part of registration. (Parents, use your email address above, please)
*Gender:
*Grade Level Completed:
*Birthdate:
*Allergies (drugs, foods, etc.):
Health Conditions and Physical Limitations:
Home Church:
*Parent/Guardian Names:
*Phone Number to be reached during BKCs, if needed:
By submitting this form you agree to the terms and conditions listed below. TERMS/CONDITIONS I/We, the parents or guardian of the above named child, hereby give approval for my/our child to participate in any and all Collierville First Baptist Church activities. I/We assume all cost, risk and hazards incidental to such participation, including transportation, feeding, and recreation. I/We hereby grant permission for any church staff or adult sponsor present to obtain necessary medical, dental, or mental health treatment in case of sickness or injury to my child when I/we are not available to grant authorization and agree I/we shall be financially liable for said treatment and agree to indemnify and hold harmless Collierville First Baptist Church, BKC Host Home and its staff and adult sponsors for any such treatment. I/We do verify that the above information is correct, and waive, release, absolve, indemnify and agree to hold harmless Collierville First Baptist Church, BKC Host Home and its staff, sponsors, supervisors, service providers and chaperones from any claims, demands and actions arising out of damage or injury to my/our child while participating in Collierville First Baptist Church activities whether the result of negligence or for any other cause. 
*Checkbox:
I, the undersigned, give Collierville First Baptist Church permission to photograph and/or video my child(ren). I further give Collierville First Baptist Church permission to use photograph(s) or video(s) of my child(ren) for publicity or other purposes including, but not limited to, newsletters, church publications, media publications, and/or on the internet-website. I also release from any liability Collierville First Baptist Church, its employees and/or volunteers in relation to the taking and/or displaying of any photographs/videos. I understand that I will be given no compensation for the use of any photographs and/or videos. 
*Options List:
loading