College for a Day Registration

Name*

First NameLast Name

Birthdate*

Date

MaleFemale

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Church/School Name*

High School Junior (11th)High School Senior (12th)Other (please specify in comment box at the end)

T-Shirt Size*

Athletic Waiver and Release of All Claims – Each person attending must have a waiver signed by their guardian(s).

The Dayspring Bible College & Seminary located at 27875 N. Fairfield Rd. Mundelein, IL and the Quentin Road Baptist Church located at 24126 N. Quentin Rd. Lake Zurich, IL release form is for all church, college, preschool, and Christian school activities including any gymnasium, sports, swimming, off-campus trips, horseback riding, barn activities, and all other activities.

PLEASE READ THIS FORM CAREFULLY AND BE AWARE THAT IN SIGNING THIS YOU WILL BE WAIVING AND RELEASING ALL CLAIMS FOR INJURIES YOU OR YOUR CHILD MIGHT SUSTAIN ARISING OUT OF THE PROGRAMS WHILE UNDER SUPERVISION OF THE DAYSPRING BIBLE COLLEGE/QUENTIN ROAD BAPTIST CHURCH.

Acknowledgment of Risks of Injury Clause: “As a participant in this church/college/preschool/Christian school, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries including death, damages or loss which I or my child may sustain as a result of participating in any and all activities connected with or associated with such programs.”
Waiver of Claim for Injury Clause: “I agree to waive and relinquish all claims I may have as a result of participating in the programs against the Dayspring Bible College/Quentin Road Baptist Church and Christian School and Preschool and its employees.”
Release from Liability Clause: “I do hereby fully release and discharge the Dayspring Bible College/Quentin Road Baptist Church and Christian School and Preschool, its employees and or agents from any and all claims from injuries, including death, damages or loss which may accrue on account of participation in these programs.”
Indemnity and Defense Clause: “I further agree to indemnify and hold harmless and defend the Dayspring Bible College/Quentin Road Baptist Church and Christian School and Preschool and its employees from any and all claims resulting from injuries, including death, damages and losses sustained and arising out of, connected with, or in any way associated with the activities of the programs.”

This release, indemnification and hold harmless agreement is executed by the undersigned in consideration of Dayspring Bible College, Quentin Road Baptist Church and Quentin Road Christian School and Quentin Road Christian Preschool allowing my child to participate in the above described activities and all other related program activities and other good and valuable consideration, sufficiency of which is hereby acknowledged.

Agree

Parent/Guardian Signature (or Participant if over 18)*

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