Participant's Full Name
*
First Name
Last Name
Grade
*
Please Select
6
7
8
9
10
11
12
NA
Participant's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Participant's Email
example@example.com
Legal Parent/Guardian Authorizing Participation
*
First Name
Last Name
Parent/Guardian's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian's Email
*
example@example.com
Emergency Contact Name & Phone No.
*
I personally, and on behalf of said minor, clear and release Foster Chapel Baptist Church, its business partners and volunteers from any claim for personal injuries that might be sustained while on such trips or while returning to their homes.
*
Please Select
YES
NO
In the event of an emergency, I consent to emergency medical treatment of the minor participant listed while in the care of the J.E.W.E.L.S. Ministry leaders.
*
Please Select
YES
NO
I hereby authorize J.E.W.E.L.S. and its agents to take and use photos/videos of my minor child/children identified above.
*
Please Select
YES
NO
List Food Allergies
*
NA if none
Submit
Should be Empty: