D-Now Registration

FBC Pompano Beach Student Ministry

A discipleship weekend "overnighter" for students in 6 -12 grade. Students will be staying in host homes and participating in Bible study small groups as well as large group meetings and activities. Registration fee $55.00 per student; registration starts on December 2, 2018.

Insurance Information

Medical Information

Please indicate reason for each medication.

Release Information

I am the parent or legal guardian of the student named above, a minor, and has given my consent for him/her to attend events being organized by the Church, including the event specified above. I understand that there are inherent risks involved in any ministry or athletic event. I voluntarily elect or accept and solely assume all risk of damages and injury incurred or suffered by the student named above while attending events organized by the Church, including any and all liability, claims, damages, and costs for any injury, loss, or damage to person or property that may occur during the course of my child’s involvement in events organized by the Church, including the event specified above. I further agree that I shall hold harmless and fully indemnify the parties hereby released from any claims, damages, and costs including attorney fees, which may arise from any claim or cause of action, made by me, through me, or on my behalf. In the event that my child is injured and requires medical attention, I consent to any reasonable medical treatment as deemed by a licensed health professional. In the event treatment is required from a licensed health professional and /or hospital personnel designated by the Church, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such medical care. I also agree to hold harmless and release the Church, its pastors, employees, agents, volunteer workers, and representatives from any and all liability related to expenses arising from the giving of such medical care to the extent those expenses are not reimbursed by my or the student’s health insurance. Further, I affirm that the health insurance information provided above is accurate at this date and will, to the best of my knowledge, still be in force for the student named above at the time of the event specified above. I also agree to bring my child home at my expense should he or she become ill or if a student ministries staff member deems it necessary. I understand that I am responsible for the registration cost towards this trip and that this form does guarantee my child a spot on the aforementioned trip. In case of cancellation, a registration fee will not be refunded.
I ACKNOWLEDGE THAT I HAVE READ AND THAT I UNDERSTAND EACH AND EVERY ONE OF THE ABOVE PROVISIONS IN THIS WAIVER, CONSENT, RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT AND AGREE TO ABIDE BY THEM.
Price: $ 55.00
/