D-Now 2018 Registration Form
Disciple Now (or D-Now) is an annual event where students participate in Bible Study at church and in homes of church members of Grace Fellowship Church. Students will also be transported to various destinations via vehicles of adult drivers (over 18) and church passenger vans. There will be recreation activities throughout the weekend that the individual student can decide to participate in.
From 6:00pm February 23rd To Noon February 25th
$25 per student; T-Shirt provided; Food provided
Payment can be made through PayPal to students@gracekaufman.org. If paying directly from your bank account using for Friends and Family, please send $25. If you are using a credit/debit card, please send $26 to cover the processing fees.
Student's Name *
Your answer
Grade *
Student's Date of Birth *
MM
/
DD
/
YYYY
Gender *
Student's Address *
Your answer
Student's Phone Number (if student has no phone, enter "none") *
Your answer
Student's Email Address (if student has no email address, put "none") *
Your answer
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name *
Your answer
Is your address the same as your child? *
If you marked no to the previous question, enter your address
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email Address *
Your answer
ADDITIONAL INFORMATION
Student's T-Shirt Size *
Does student have any special food requirements or allergies? *
If you marked "yes" on the previous question, please list your student's special food needs.
Your answer
Please list any medical issues that the Grace Fellowship staff may need to be aware of including other allergies (latex, insects..etc), physical concerns, limitations, disabilities, chronic illness, recent injury, or medical condition. If there are none, please enter "none." *
Your answer
Please list any medication that your student will/may need to take over the D-Now weekend. For each medication, comment on when it needs to be taken. If there are none, please enter "none." *
Your answer
LEGAL SECTION
Do you consent to the use of your electronic signature for granting permission for your student to attend D-Now at Grace Fellowship? *
Required
By entering my full name below, the participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation in the activity described above. Except for gross negligence on the part of the sponsor, the participant (or parent/guardian) accepts personal financial responsibility for any bodily personal injury sustained during the activity. Further, the participant (or parent/guardian) promises to hold harmless the sponsoring organization and its representatives for any injury related to the activity. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable arbitration process. *
Your answer
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