HAC | 2023 Spring | College Days Registration

College Days Registration — Spring 2023

April 5-7, 2023
Full Name:*

First NameLast Name
I am a:*
Age:*
(Those over 21 years of age will not be permitted to participate in College Days.)
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*

Area CodePhone Number
E-mail:*
Gender:*
I would like to stay in the residence halls*

YesNo
Referred by:
Contact Person (If coming with group):
Church Information:*
Contact Number:*

Emergency Contact:*

First NameLast Name
Relationship to Delegate:*
Emergency Contact's Phone Number:*

Area CodePhone Number
Parent/Guardian (if different than above):

First NameLast Name
Parent/Legal Guardian's Phone (if different than above):

Area CodePhone Number
By signing your name and initials below, you agree to the following:
- I attest that my child has no existing medical conditions that would endanger him/her from participating in any/all College Days activities.
- I give permission for my child to participate in Hyles-Anderson College/College Days activities. In the event of injury, I agree to hold harmless (which means to not assign blame or legal responsibility) Hyles-Anderson College/First Baptist Church and those workers assisting in the activity from any and all harm that may be sustained as result of or during the activity, including transportation to and from the activity.
- I give permission for my son/daughter to ride in any vehicle designated by the adult in charge.
- I give permission for the person in charge to seek medical services if needed.
By signing your name and initials below, you agree to the following:
- I attest that I have no existing medical conditions that would endanger me from participating in any/all College Days activities.
- In the event of injury, I agree to hold harmless (which means to not assign blame or legal responsibility) Hyles-Anderson College/First Baptist Church and those workers assisting in the activity from any and all harm that may be sustained as result of or during the activity, including transportation to and from the activity.
- I give permission for the person in charge to seek medical services for me if needed.
This is to be signed by a parent/legal guardian for those under 18 years of age or by the delegate if over 18 years of age.*

Clear
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College Days Registration — Spring 2023

By signing your name and initials below, you agree to the following:

By signing your name and initials below, you agree to the following: