HHWC Fall Overnight Youth Registration Form

HHWC Fall Overnight

Sunday, October 12 6:00pm - Monday, October 13 noon
Parent/Guardian Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

City

Zip Code
Cell Number*
E-mail*
example@example.com
Youth to Attend
Total Number of youth entered above*
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Do any of the Youth have any allergies, chronic illness, or medical conditions? If yes, please list the youth's name and condition below.*

Total Donation ($10/per child; 3 or more, $25 total)*

USDDescription

Credit Card

Cash App Pay

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by His House Worship Center during the above event. In exchange for the acceptance of said child’s participation by His House Worship Center, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless His House Worship Center and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of any activities of reasonable premise during the above event.

In case of injury to or sickness of said child, I hereby waive all claims against His House Worship Center including all leaders and volunteers, all participants, and, if applicable, owners and lessors of premises used to conduct the event.
Confirmation

BY SUBMITTING BELOW, I AM SENDING AN ELECTRONIC AGREEMENT THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE SUBMISSION WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

ALL PAYMENTS ARE NON-REFUNDABLE!
Should be Empty:

HHWC Fall Overnight