Bridge Builders Registration Form:
Please complete the form to register your child. If registering more than one child, you will be given an opportunity to complete another form after hitting submit. Complete 1 form for each child you are registering.
Email address *
Parent's First Name: *
Your answer
Parent’s Last Name: *
Your answer
Parent’s Email Address: *
Your answer
Parent’s Phone Number: *
Your answer
Student's First Name: *
Your answer
Student's Last Name: *
Your answer
Student's Grade Level: *
School your child attends: *
Your answer
Does your child have any food allergies or medical conditions?
Your answer
I, the undersigned, as a parent/guardian of the child participant in the Bridge Builders Leadership Initiative and other activities associated therewith do hereby acknowledge that my child(ren) and I understand the inherent risks (including but not limited to serious bodily injury or death) of physical exertion and manual labor and athletic events and hereby warrant that I am physically healthy enough to participate in such activities. My child(ren) and I have sought medical attention for any and all health conditions known to me, and have been cleared by medical professionals to participate in such activities. My child(ren) and I understand the rules, regulations, provisions, standards, and obligations of participating in events such as will be undertaken by this Program. My child(ren) and I agree not to take any action or make any statement which may damage any member of the program or any person or organization being assisted by the Program and its volunteers at any time before, during, after or in conjunction with the community service projects. My child(ren) and I fully release the Bridge Builders Leadership Initiative, the Bridge Church, the Pearl Public School District, the City of Pearl, Mississippi, and the pastors, members, officers, agents, servants, employees, independent contractors, volunteers, participants, principals, officials, teachers, faculty, school board members, heirs and assigns of same and agree to hold them harmless of any liability arising from any injuries sustained while participating in the “Bridge Builders Leadership Initiative” and affiliated programs and other activities associated therewith. *
Permission to Use Photograph: I grant Bridge Builders Leadership Initiative, the City of Pearl, and The Bridge Church the right to take photographs of my child (named above). The photographs may be used with or without name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. *
Transportation Waiver: I, the undersigned, hereby release, waive, discharge and covenant not to sue the Bridge Builders Leadership Initiative, the Bridge Church, the Pearl Public School District, the City of Pearl, Mississippi, and the pastors, members, officers, agents, servants, employees, independent contractors, volunteers, participants, principals, officials, teachers, faculty, school board members, heirs and assigns of same (hereinafter referred to as releasees) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my minor child(ren) or me, or any of the property belonging to me, as result of, or in any way arising out of my child(ren) traveling to and or from Bridge Builders Leadership Initiative sponsored activities in a vehicle or vehicles not owned or operated by releasees.I voluntarily assume full responsibility for any risks of loss.I further hereby agree to indemnify and hold harmless the releasees from any loss, liability, damage or costs due to my child(ren) traveling to and or from the Bridge Builders Leadership Initiative sponsored activities in a vehicle or vehicles not owned or operated by the releases.I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed and enforced in accordance with the laws of the state of Mississippi. In signing this release, I acknowledge and represent that I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed. *
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