2024-2025 MISSION FRIENDS REGISTRATION FORM

2024-2025 Registration Form
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Name of School/Program
What interests or hobbies does your child have:
Please list all food allergies or medical conditions:
Please list any special conditions or information we may need to know about your child to enhance their club experience, toilet schools, dressing, etc.
What church does your family attend?
Parent/Guardian location during Mission Friends*
Please let us know if you are dropping off, attending a Bible Study, or if you are able to volunteer.

Family Information
Parent/Guardian's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Mother's Occupation
Father's Occupation
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1. Approved Person for Pick-Up

First NameLast Name
2. Approved Person for Pick-Up

First NameLast Name

Optional Donation

USDThere are no fees for participation, but the actual cost of the program is approximately $30 per year. Donations are optional.

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

PARENTAL PERMISSION & WAIVER OF LIABILITY:
(For Children under the age of 18):
I hereby give permission for First Name Last Name , who is my child/guardian, to participate in all events sponsored by Byne Memorial Baptist Church. I release and agree to hold harmless Byne Memorial Baptist Church from any and all liability for personal injury and/or illness, including medical expenses, of any nature that occur while my child is participating in such events.

I hereby release and agree to hold harmless Byne Memorial Baptist Church from any and all liability for personal injury and/or illness, including medical expenses, of any nature that occur as a result of my participation in any physical activity or exercise program sponsored by the church.

MEDIA RIGHTS RELEASE
By signing below, and for the good and valuable consideration of participating in an program hosted by BYNE I hereby give my full consent to BYNE (“BYNE”), a GA nonprofit corporation, to record, by writing, by video, photographic, or audio recording device, or by any other analog or digital means, my actions, physical likeness, biographical information, and/or voice. Additionally, I hereby grant to BYNE, without royalty or other compensation now or in the future, all rights of every kind and character whatsoever, in perpetuity, in and to any and all such recordings, along with any additional recordings I might provide to BYNE, and to any benefits inuring to BYNE as a result of its use of any of the foregoing recordings. Among other things, BYNE may, but are not required to, copy or reproduce the recording, edit or modify it, incorporate it into another work, display or broadcast it or any of the foregoing privately or publicly, and use or license it or any of the foregoing for use by others, all for the sole benefit and at the sole discretion of BYNE, for the advancement of BYNE's exempt charitable purposes. All permissions granted herein extend to any successor or assign of BYNE and bind me and my heirs, successors, and assigns. I, hereby release and discharge and agree to hold harmless BYNE, its directors, officers, employees, volunteers, and independent contractors, from any and all claims or damages, including but not limited to defamation or violation of rights of privacy or publicity, arising from or associated with the recordings or use of recordings. This release shall be construed, interpreted and governed in accordance with the laws of the State of Florida, and should any provision of this release be determined invalid, such invalidity does not affect any of the remaining provisions. I am of full age and have the right to contract in my own name.
Signature*

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2024-2025 Registration Form

Family Information

Payment Methods