Ignite Conference Adult Registration Form
First Name
Last Name
Gender
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Number
Please enter a valid phone number.
Format: (000) 000-0000.
Does the you have any allergies? If yes, please list them below:
Do you have any medical condition that we should be aware of? If yes, please explain below:
Back
Next
Emergency Contact
Name
First Name
Last Name
Relationship to You
Telephone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Back
Next
Terms and Conditions
I allow my child to participate in this program.
I hereby authorize the church, bible study conductor, volunteer personnel to conduct first aid, and medical care in the event of an emergency situation. I agreed to pay for all the medical care expenses and costs in a given situation that medical care is needed.
I release the organizers from any liabilities that might happen during the activity and hold them harmless in the event of damages, injuries, or accidents.
I confirm that all information in this form is accurate and true to the best of my knowledge.
Do you allow the organizers to take photos or videos during the activities of your child for advertising and marketing purposes that will be posted on social media?
Yes
No
Parent/Guardian Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: