Pop Spring Youth Student Registration

Select One Use this only if you Attend Poplar Spring Baptist Church or wish to join youth Ministry at Poplar Spring (GPS Students only)

Parent Name*

PrefixFirst NameLast Name

Cell*

Area CodePhone Number

E-mail*

Studen 1 Name*

PrefixFirst NameLast Name

Name of Church or Organization

ex: 9/20/2008; 11 Years old

Do you attend Poplar Spring?

ex: 9/20/2008; 11 Years old

Youth Group Name & How Many Students

Upload your picture Student 1

Browse Files

T-shirt Size for GPS Students Only

Please list all known allergies for student 1

Studen 2 Name

PrefixFirst NameLast Name

Student 2 Age

Upload your picture Student 2

Browse Files

T-shirt Size GPS Students only

Studen 3 Name

PrefixFirst NameLast Name

Student Age

Upload your picture Student 3

Browse Files

T-shirt Size GPS students only

List School(s)

ex: 9/20/2008; 11 Years old

In the case of an emergency please contact:

PrefixFirst NameLast Name

Cell

Area CodePhone Number

Poplar Spring Activity, Video, Picture, & Participation Release:

Poplar Spring Youth Ministry and Poplar Spring Missionary Baptist, separately and/or collectively, have the right to use my picture, silhouette and other reproductions of likeness, performance, music and voice in connection with the promotion of Poplar Spring Church, Youth Ministry for media material promoting in any packaged recordings produced by Poplar Spring Baptist Church.

Poplar Spring Baptist Church shall have all rights, title and interest in any all results and proceeds from said recordings, advertisement’s images or appearance. Rights are perpetual and include the use of any and all interviews, performances, recordings in any medium, pictures or images.

I (we), parent or guardian, hereby give my consent for the above-names child to be taken under the care, custody, control and supervision of Poplar Spring Youth Youth Ministry staff, volunteers and advisors, in conjunction with, youth ministry events, block parties, classes, singing concerts, rehearsals or performances and to any point that is necessitated during the upcoming schedule.

I do hereby release and hold harmless the above named individuals, volunteers, and other sponsors connected with the youth ministry, for any suit or claim for damages which may arise affecting my (our) child while under the control, care and/or supervision of the above listed individuals directly causing any injuries to my (our) child (save direct negligent behavior). This release of liability and hold harmless agreement is essential to the participation of my (our) child in such activities and, it is understood that if this agreement is not signed that my (our) child shall not accompany nor participate in the activities above described.

This document is to further authorize and empower the above named individuals and or other sponsors and officials of the organization to sign and grant emergency treatment on minor incidents. Guaridan grants permission for a register nurse or similar person trained in the medical field as may be reasonable and necessary for the treatment of my child, during any time that my child shall be under the supervisor of staff, volunteers, an advisors while at rehearsal, events, concerts, or while engaging in any activity associated with Poplar Spring Youth Ministry.

Fall Festival Release

There will be fun games that could also have minor risk. Parents and guardians must supervise students at all times. Below is the release form for activities taking place October 26 at at Poplar Spring Baptist Church, Simpsonville, SC.

In consideration of being allowed to participate in the fall festival (hereinafter the “Event” or “Activity”), and intending to be legally bound, I hereby for myself, my heirs, executors, administrators and assigns, waive and release all rights and claims for damages which I may have now or in the future against volunteers and staff arising out of or relating in any way to the Event, including all claims for personal injuries and/or property damage sustained by me before, during, or after said Event, whether caused or alleged to be caused in whole or in part by the negligence of staff and volunteers. I also hereby covenant not to sue Poplar Spring, it's staff or volunteers for any matter arising out of or connected with the Event. I also grant Poplar Spring the irrevocable and unrestricted right to use and publish photographs or video of me, or which I may be included, for editorial trade, advertising, or any other purpose and in any manner and medium; and to alter the same without restriction. I am 100% responsible if any equipment is damaged or destroyed by myself, the group I represent, or anyone participating in the event scheduled.

I recognize that the Event involves activities that are physically demanding and which carry a possibility of serious injury, including permanent disability or death. I hereby warrant and represent to Poplar Spring Baptist: (a) that I am physically and emotionally fit and sufficiently trained to participate in and complete the Event or Activity; (b) that I knowingly and voluntarily assume all risk and responsibility whatsoever associated with my participation in the Event; and (c) that I have carefully read and fully understand this Waiver and Release and willingly agree to all of the conditions and obligations set forth herein. By entering my name and personal information in the below form, I agree to the above terms and conditions and represent myself and the organization I work or volunteer at.

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