REGISTRATION
Summer Blast 2021
July 24 from 4:30-7:30PM
@ Kenleigh's Retreat
3255 S Pamplico Hwy #51, Pamplico, SC 29583
Parent/ Guardian Name(s): *
Mailing Address: *
Phone: *
Email: *
Names and Ages of Children *
Number of family members attending *
Interested in other ways to connect through The Jade Bridge? Check each option you'd like to have more information about and we'll contact you with more information! *
Required
How did you hear about Summer Blast 2021? *
Required
LIABILITY WAIVER: By signing this Waiver and Assumption of Risk, I fully assume the dangers and risks, and agree to use my best judgment while engaging in the Summer Blast 2021 activities. I will assume all responsibility for supervision and safety of all minor children in my care. I further agree to indemnify and hold harmless the Releasee (The Jade Bridge), its employees, agents, and officers from and against any and all liability incurred as a result of or in any manner related to my participation in the activities. Please type your full name below to serve as your digital signature. *
PHOTO RELEASE: The Jade Bridge has permission to use photos of myself and children for future publications and/or social media promotions of like events. *
Required
Typing your full name serves as your digital signature, acknowledging you have read and appropriately marked the PHOTO RELEASE. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy