DNow 2018 Registration
FBC Madison Student Ministry
Registration Ends January 1, 2018
$50 per student
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) *
Name of Church you are attending with (If you are in Madison, please list the church name of the YOUTH GROUP you attend) *
Your answer
Parent/Guardian Name *
Your answer
Emergency Contact (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
Saturday Ministry Options: Construction Crew, Community Crew, Children's Crew (Type your FIRST CHOICE first, your SECOND CHOICE second, and your THIRD CHOICE third). *
Your answer
If you would like to do construction, what are some things you have been a part of where construction was involved? (Ex. Mission trip, mission possible day, fence building, etc.) If you have no experience in construction, type "no experience" (that doesn't preclude you from a construction crew if you would like to be a part of one). *
Your answer
List any skills you have or experience you have working with children: *
Your answer
Would you be willing to be a crew encourager? (entails having evangelism training, leading your crew in evangelistic opportunities at your crew site, keeping your crew on point, reporting to your crew chief any decisions made for Christ) *
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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