DNOW 2019 Registration
The ROCK Student Ministry
First Baptist Church
Madison, Florida

Disciple NOW 2019
January 11-13
$50/Student

Special Guest Speaker - Billy Young, Next Generations Ministry Leader of the Florida Baptist Convention
Special Guest Worship Band - Commotion from Redland Baptist Church, Clyattville, Georgia

Participant Name (First and Last) *
Your answer
Male or Female *
Address *
Your answer
City, State, Zip *
Your answer
Phone # *
Your answer
Grade in School *
T-Shirt Size (Adult Sizes) *
Parent/Guardian Name *
Your answer
Emergency Contact Name (Non-Parent/Guardian) *
Your answer
Emergency Contact Phone # *
Your answer
Insurance Carrier *
Your answer
Policy # *
Your answer
Insurance Phone # *
Your answer
Physicians Name *
Your answer
Physicians Phone # *
Your answer
List any medical conditions FBC Student Ministry Leaders/Staff should be aware of: *
Your answer
List any medications: *
Your answer
List any allergies: *
Your answer
As the parent/legal guardian of the above listed student, I have reviewed the information about the DNOW, and give permission for the subject of this release to be involved in the overall activities. I/We understand all reasonable safety precautions will be taken at all times by First Baptist Church, Madison and its agents during the events and activities. I/We authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of emergency. I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/We agree not to hold First Baptist Church, Madison, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form. *
Signed (Type in your first and last name): *
Your answer
Date: *
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DD
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YYYY
I/We give permission for my student to be photographed and for the photo to be placed on any of our student ministry social media sites: *
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