Participant's Full Name
*
First Name
Last Name
Grade
*
Please Select
6
7
8
9
10
11
12
N/A
This Field is Require
Participant's Phone Number
*
-
Area Code
Phone Number
Participant's Email
*
Legal Parent/Guardian Authorizing Participation
*
Parent/Guardian's Phone Number
*
-
Area Code
Phone Number
Parent/Guardian's Email
*
Emergency Contact Name & Phone No.
*
I personally, and on behalf of said minor, clear and release Foster Chapel Baptist Church, its business partners, and volunteers from any claim for personal injuries that might be sustained while on such trips or while returning to their homes.
*
In the event of an emergency, I consent to emergency medical treatment of the minor participant listed while in the care of the J.E.W.E.L.S. ministry leads.
*
I hereby authorize J.E.W.E.L.S./its agents to take and use photos/videos of my minor child/children identified above.
*
List Food Allergies
*
Enter "NA" if None
Submit
Should be Empty: