Wild Week 2021
Wild Week is an incredible week at Crowder’s Ridge in Gastonia, NC filled with rec games, team challenges, late night events, and more! People will talk about this week all year, you do not want to miss out!For students who have COMPLETED 5th-7th grades as of May 2021. $50 non-refundable deposit due at time of registration.
Grade Completed as of May 2021
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
One person I'd like to room with
Insurance Policy Number
I, as the parent or guardian of the student in this registration and by this instrument, I do hereby release, acquit, hold harmless and forever discharge FIRST BAPTIST CHURCH CONCORD, 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 my child 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 FIRST BAPTIST CHURCH CONCORD. By signing this agreement, I give my permission for my child to receive medical attention in the event of an emergency. It is my responsibility to provide current and correct insurance information to the Student Ministry offices and my responsibility to update such information should it change within the year. I understand and will allow photos and videos of my child to be taken while at FIRST BAPTIST CHURCH CONCORD to be used in any FIRST BAPTIST CHURCH CONCORD publication. I also understand that publication of these photographs may be accomplished electronically via the Internet and that after publication, the church will be unable to prevent persons from gaining access to the Internet, copying my photographs and video from there, and subsequently using, altering, or republishing them without my consent. I waive any claim for damages against the church from unconsented use, alteration, or republishing of my photographs and video by third parties accessing the Internet. I certify that I have read this document, and I fully understand it’s contents/ I am aware that this is a release of liability and a contract and I sign it of my own free will. TYPE SIGNATURE OF PARENT OR GUARDIAN:
I understand this counts as a legal signature
( X )
Wild Week Deposit
Credit Card Number
Should be Empty: