Plain Church Youth Registration
Please fill out your details to register for the event.
Participant's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Name (if under 18)
First Name
Last Name
Parent/Guardian Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
I give my permission for my child to participate in the above-mentioned activity. I understand that my child will be under the supervision of Plain Church staff and volunteers during the activity and that all reasonable precautions will be taken to ensure their safety. I also acknowledge that there may be risks associated with this activity, and I accept them on behalf of my child.
*
Agree
I release Plain Church, its staff, and volunteers from any liability for any injury or illness that may result from the activity.
*
Agree
In the event of an emergency, I authorize Plain Church staff to seek medical attention for my child
*
I give consent for medical care
I do not give consent for medical care
I understand that my child is expected to follow all rules and regulations during the activity.
*
Agree
I give my permission for Plain Church to take my child’s picture and to use this photograph for the purposes of public relations and community outreach.
*
I give permission
I do not give permission
Signature
*
Register
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