2023 Kentucky WMU Kids Group Registration & Payment Form

Kentucky WMU Kids GROUP REGISTRATION
EVENT(S):

GA JAM
SECTION 1: GROUP REGISTRATION
NOTE TO LEADER: This is the first of several forms that must be completed for participation. Group information, parental release forms, and confirmation information will be emailed to the email address provided below.
Date*

MonthDayYear
Date
For Which Events are you Registering

GA JAM (Richmond)
Church Information
Church Name*
Association*
Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church Phone Number*

Area CodePhone Number
Church Email*
example@example.com
Group Leader/Coordinator Information
Group Leader/ Coordinator Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Group Leader Email*
example@example.com

SECTION 2 GROUP LEADER'S AGREEMENT

Please SIGN indicating that you have read and understood the authorizations and releases below. Sign and date the bottom of the form to indicate your understanding of and agreement with all statements provided. Ensure signature of senior pastor as well.
AS LEADER OF MY GROUP, I AGREE TO:
1. Enlist capable adult leaders for whom my church has performed a criminal background and cleared to work with minors pursuant to Kentucky State Law.
2. Have each adult participant or the legal guardian of each minor fill out a Medical Release Form. (We will email you these forms upon submission of this group registration form to the email address you've provided). These forms can be submitted digitally by June 1. A printable version can be sent upon request and emailed to stacy.nall@kybaptist.org NO ONE WILL BE ABLE TO PARTICIPATE WITHOUT A MEDICAL RELEASE FORM.
3. Be accountable for the actions/behavior of my students while at the EVENT. This includes taking care of the facility where my students will be housed during the EVENT.
I have read and agreed to all the above statements.
Group Leader Signature*

Clear
Date*

MonthDayYear
Date

SECTION 3 Participant Registration Information & PAYMENT

*All registrations are secured by PAYMENT. THESE are non-refundable. If, however, Kentucky WMU has to cancel the event, we will refund your payments. Once your deposit is received, Kentucky WMU will send a confirmation email for your records. Unused payments may be applied to the fee of a substituted participant subject to approval by Kentucky WMU office. If you wish to pay by check, please contact Stacy.Nall@kybaptist.org for the corresponding coupon code.

Projects*

GA JAM Registration (Richmond)CODE: GAJAMEARLY by Oct 21 for Early Bird Rate

$20.00

Adult or Student	# of Adults & Students	Type	Price
Adults			$20.00
Students			$20.00

Item subtotal:$0.00

Explore Registration (Richmond)Due to limited space, we request no more than 2 leaders for every 1-7 children CODE: EXPLOREEARLY by June 12 for Early Bird Rate

$18.00

Adult or Student	# of Adults	Price
Adults		$18.00
Children		$15.00

Item subtotal:$0.00

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Kentucky WMU Kids GROUP REGISTRATION

SECTION 1: GROUP REGISTRATION

Church Information

Group Leader/Coordinator Information

SECTION 2 GROUP LEADER'S AGREEMENT

SECTION 3 Participant Registration Information & PAYMENT