IMPACT WEEKEND 2024

Impact Weekend 2025 Details:

February 21-23, 2025
6-12th Grade
COST: $50

Impact Structure:

Check-In will be Friday, February 21 at 5PM
Students will stay the night at either a host home or the church on Friday night.
Students will be dismissed from Impact Weekend after church Sunday Morning.

Important Locations:

Worship Services, Breakouts, Dinner on Saturday: First Southern Baptist Church in Del City (6400 S Sooner Rd, OKC, OK)
Host Homes: Students will stay in various church member homes or at the church throughout the weekend.
First Baptist Church, Nicoma Park (1931 Nichols Drive, Nicoma Park, OK)

Student Information

Will you need a scholarship?*

Full Name*

First NameLast Name

Grade*

Gender*

MaleFemale

Shirt size*

Phone Number

E-mail

example@example.com

Parent/Guardian Information

Full Name*

First NameLast Name

Phone Number*

E-mail

example@example.com

Emergency Contact (other than parent)*

First NameLast Name

Emergency Contact Number*

Relationship to Student

Medical/Photo Release Form

Name of Insurance Policy Holder

Medical Insurance Company

Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Company Phone Number

Please enter a valid phone number.

Policy Number

Group Number

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.

I hereby authorize any staff member and/or adult sponsor who may be supervising or directing ALL activities sponsored by First Baptist Church of Nicoma Park to obtain any necessary medical and/or surgical treatment for my son or daughter in the event of an emergency due to sickness or accident at any scheduled event/activity or travel to and from such event.

Also, I will allow a sponsor to distribute prescribed medication AND over the counter medications to include: Tylenol, Ibuprofen, Benadryl, and Pepto-Bismol when needed.
I understand that if medical treatment is required, every effort will be made to contact my family doctor and/or me. However, if neither can be reached or the situation demands immediate attention, I give my permission to any staff member and/or adult sponsor of First Baptist Church of Nicoma Park to secure the services of a licensed physician to provide the care necessary.

Furthermore, I release and agree to hold harmless First Baptist Church of Nicoma Park, its staff, employees, and sponsors from any liability for personal injury, damage or loss that the above named person may sustain while participating in any event/activity sponsored by First Baptist Church of Nicoma. I also agree to be responsible for ALL cost associated with my child's treatment and will reimburse First Baptist Church of Nicoma Park for any expenses incurred.

I agree to allow the staff and sponsors selected by First Baptist Church of Nicoma Park to reasonably discipline my child during any activities sponsored by First Baptist Church of Nicoma Park if, in the sole judgment of such staff sponsors or other designated sponsor, such reasonable discipline is necessary. I have explained to my child the attitude and actions expected during such activities. If any staff sponsors or other designated sponsors deem it necessary for my child to return from any trip due to illness, injury, or misconduct, I agree to be responsible for all cost associated with such a return trip and reimburse First Baptist Church of Nicoma Park for any expenses incurred.

Furthermore, I give my permission to allow the above named person's image (photograph or video) to be used in promotional resources of First Baptist Church of Nicoma Park, such as brochures, slideshows, website, etc.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

IMPACT WEEKEND 2025