Clone of The Intentional Marriage Registration Form

Teen Night - Called to Excellence

Please fill in the form below to reserve your seats!
Teen Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
E-mail*
example@example.com
Do you have any dietary allergies? We cannot accommodate all dietary needs. However, when possible, we will try to do what we can. We will contact you with options, if available.
Participation Waiver And Release Form
Participant Name*

First NameLast Name
DOB*

MonthDayYear
Date
Guardian Name (if participant is under 18)

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
I am aware of the dangers of attending this event on this particular date. I promise not to hold Kentucky Lumber, its officers, agents, employees or the Guyer family liable or pursue legal action against them. This waiver absolves Kentucky Lumber and the Guyer family of any duty for injuries sustained on the premises before to, during, or after the activity.
By signing this agreement, I agree to hold Kentucky Lumber and the Guyer family completely harmless, including financial responsibility for any injuries sustained, regardless of the cause or circumstances.
I will do all in my power to obey corporate staff and all safety requirements, and I will seek clarification if necessary.
Participant Signature (or Guardian if participant is under 18)*
Today's Date*

MonthDayYear
Date
Photo Release: We may take pictures of the event for use on our website and social media pages. Please choose below whether or not you allow your photos (or the photos of your minor) to be used in such a way.*

I give Kentucky Lumber permission to use photos of myself (or of my minor) from this evening's event on their website and on their social media pages.I DO NOT give Kentucky Lumber permission to use photos of myself (or of my minor) from this evening's event on their website and on their social media pages.

My Products*

Registration Fee / teen (Required)

Registration includes dinner for one person and supplies for the service project.

$20.00

Donation for Supplies (OPTIONAL)

This is an optional donation to help cover additional supplies for the service project. Please enter the amount below if you'd like to donate.

$1.00 Dollars

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

CANCELLATION POLICY: If cancellation is made prior to 7 days before the event, a full refund will be given. After 7 days before the event, only partial refunds (minus cost of the dinner) will be given. If we have a waiting list and are able to refill your seat, a full refund will be given.*

I understand and agree to the cancellation policy.
Should be Empty:

Teen Night - Called to Excellence

Participation Waiver And Release Form