Registration Form
Just some formalities for WHC Students
Name of Student *
Your answer
Email *
Your answer
*
Birthday *
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Grade
Your answer
Home Address *
Your answer
Home Phone Number *
Your answer
Parent / Guardians Name *
Your answer
Parent / Gardians Name
Your answer
Waiver Liability
I, the parent or legal guardian of the child listed above, release WHC Student Ministries, together with the adults in charge, from any and all claims resulting from injury or damage that may be sustained by my child from injury or damage that may be sustained by my child while participating in Limitless in Rogue River, Oregon from Monday June 26, 2017 to Sunday July 1, 2017. I understand that, in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give my permission to WHC Student Ministries or an adult sponsor to secure the services of a licensed physician to provide the care necessary, including anesthesia, for my child's well-being.
*
Required
Authorizing Signature *
Parent or Legal Guardian
Your answer
Date of Signature *
MM
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DD
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YYYY
Submit
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