Student Information

Student Information

Disciple Now Registration and Permission Form

February 24-26th
Disciple Now is a great opportunity for students to get some time away from the craziness of the world around them and get together with other students to focus on God. Rather than go away to a camp or weekend retreat that will cost significant amounts of money, we get the same effect by staying right here in Fannin County.

Students will be placed in small groups of 4-7 based on age and gender. Each small group will have a roughly college age mature Christian leader who will lead them through small group lessons and discussions. Each group will be staying at the home of a TBC church member who will provide breakfast and snacks for their group. (Be sure to thank your host for their hospitality!!!) They will be traveling each day from their host home to New Zion Baptist Church in Ector for our large group worship service.

This year's theme is "Prodigal." There are two types of lost people, those who know they are lost and those who do not. Small group lessons and large group worship lessons will follow this theme!

The cost for the event is $30. This will cover all meals, a T-Shirt and their small group booklet. If paying by check, please make it payable to Telephone Baptist Church.

It's going to be a great weekend! We can't wait to see you all there!!!

Student Information
Student Name:*

First NameLast Name
Birth Date:*

MonthDayYear
Current Grade Level:*
Student Phone Number:

Area CodePhone Number
Email Address:*
Primary Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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Please provide any medical or dietary restrictions the student has:

Family Information
Parent/Guardian's Name:*

First NameLast Name
Parent/Guardian's Phone Number:*

Area CodePhone Number
E-mail Address:*

Church Information
YesNo
If yes, what church does he/she attend?

Emergency Contact Information
Emergency Contact Name:*

First NameLast Name
Emergency Contact Primary Phone Number:*

Area CodePhone Number
Emergency Contact Secondary Phone Number:

Area CodePhone Number
Relationship to Student:*

Insurance Information
Insurance Company:
Name on Insurance Policy:
Group Number:
Policy Number:
Insurance Company Phone Number:

Area CodePhone Number

Additional Information
Is there any additional information that we need to know about the student?

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Consent and Waiver Regarding the Use of Photographs and Video
I hereby allow photographs and video of my child’s participation in the Telephone Baptist Church Student Ministry Event to be published via print, video, website, or social media which are affiliated with Telephone Baptist Church. I understand that publication may be accomplished electronically via the Internet, copying my child’s photographs and video there from, and subsequently using, altering, or republishing it without my consent. I waive any claim for damages against Telephone Baptist Church from the unconsented-to use, alteration, or republication of my child’s photographs and video by third parties accessing the Internet or obtaining copies of the print or video material.*

YesNo

Student Permission Form, Release, Discharge and Hold Harmless Agreement
As the parent/legal guardian of the afformentioned student, I do hereby release, acquit, hold harmless and forever discharge TELEPHONE BAPTIST CHURCH, its agents, servants, and employees, and all persons, natural or corporate, in privity with them or any of them, from any and all claims or causes of action of any kind whatsoever, including but not limited to actions, suits and/or claims for any bodily injuries, death or property damage which may be sustained by said student while participating in any activity, or activities, including travel to and from such activities and any negligence or lack of care due or claimed to be due to the conduct of any agent, servant, or employee of TELEPHONE BAPTIST CHURCH. By signing this agreement, I give my permission for this student to receive medical or dental attention in the event of an emergency. I understand that it is my responsibility to provide current and correct insurance information to the Student Ministry office.
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