Big Weekend 2022
If you filled out the First Five signup form, your place in line is held. But you will still need to complete this form to be officially registered.
Student Name
*
First Name
Last Name
Current Grade
*
Gender
*
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Cell
Please enter a valid phone number.
Parent Name
*
First Name
Last Name
Parent Cell
*
Please enter a valid phone number.
Parent Email
*
example@example.com
Who is ONE person you would like to stay in a home with?
Food Allergies
Insurance Carrier
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
*
Yes
No
Grab a special Concord Students Shirt!
Only available during registration!
My Products
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Big Weekend Registration
$
80.00
Concord Students Grey Shirt
$
15.00
Size
Youth Medium
Youth Large
S
M
L
XL
XXL
XXXL
Concord Students Heather Grey Shirt
$
15.00
Size
Youth Medium
Youth Large
S
M
L
XL
XXL
XXXL
Credit Card
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