Elevate Shuttle Bus : June 13th
Drop Off Time: 6:00pm
Drop Off Location:
USG- Building 2, Near Lot C
Clarksburg- Front of Church Entrance


Pick Up Time: 9:00pm
Pick Up Location:
USG- Building 2, Near Lot C
Clarksburg- Front of Church Entrance

All students must have this form completed in order to ensure safety of students! If you have any questions, you may email youthstaff@church-redeemer.org

Please select your Campus *
Name (First & Last) *
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Email *
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Phone Number *
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Emergency Contact Name/Relationship/Phone Number *
Your answer
Emergency Contact Name/Relationship/Phone Number *
Your answer
PLEASE READ THOROUGHLY: I understand that my family will be notified in the case of a medical emergency involving myself. However, in the event that family members cannot be reached, I authorize the calling of a doctor and providing necessary medical services in the event that I am injured or become ill. I understand that Church of the Redeemer, Inc. of Gaithersburg, Maryland or any of its agents and representatives will not be responsible for any medical expenses incurred, but that such expenses will be my responsibility, or the responsibility of my family. At some time during mission trips, Elevate youth events and other activities, experiences can include intense physical activity including hiking, continuous walking, construction, and other strenuous activities. I agree to notify the Church in the event of any health changes that would restrict me from participating in any such activities. I also understand that the team leaders may advise me to refrain from any activities that they do not feel is within my physical capability. *
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GENERAL RELEASE & HOLD HARMLESS- PLEASE READ THOROUGHLY: I am desiring to participate in the various programs, events, or activities (“Activities”) operated by, sponsored by, or connected to Church of the Redeemer, Inc. of Gaithersburg, Maryland (the “Church”) for the period of January 1, 2018- December 31, 2018. The Students name above and I and acknowledge that the Student, an agent of the Student, and/or a member of the Students immediate family or their agent, may incur one or more of the following: personal injury, bodily damage, and/or financial obligation while participating in Church Activities. The Students further understands and acknowledges that without the Undersigned’s written consent to this General Release and Hold Harmless Agreement (“Agreement”), the Church will not allow the Undersigned to participate in Church activities. Therefore, in consideration of the above information and acknowledgements, the Students, its agents, and/or family members, hereby agree to release and hold harmless the Church, its officers, directors, employees, and their agent or agents, and any parties volunteering on behalf of the Church, from all and any liability, actions, causes of actions, claims, damages, costs, expenses, or damages of any and all kinds, arising from, or related to, and Activity of the Church for the year of 2018. *
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