Girls Conference 2019

Transcription

1 Girls Conference 2019 We are SO thrilled that you are considering attending Girls Conference This year, our theme is light and our key verse is Ephesians 5:8, which reads: For you were once darkness, but now you are light in the Lord. Live as children of light. We are praying and believing that God will use this event to speak into the hearts of students and to draw each of us closer to Him. We can t wait for Girls Conference 2019! What to bring: Bible Notebook Pen Overnight bag Fast facts: Girls Conference 2019 will be held on on April 5 th and 6 th Check in begins in the Refuge (middle school building) at 5pm and goes until 5:30pm. Unless all forms have been notarized and completed prior to check in, a parent MUST accompany a student at check in. We will be staying at the Moxy, located in downtown Chattanooga. We will be providing the transportation to and from the hotel. We will dismiss at 11am from the Met (high school building) at Dallas Bay Church. The cost to attend the event is $50, which can be paid online at dallasbaychurch.com/highschool. The deadline to sign up is Wednesday, April 3 rd at midnight.

2 Student/Parent Agreement By signing this agreement, both the student and parent acknowledge an adherence to the rules stated below: 1.) Once checked-in to Girls Conference, students are not allowed to leave until our planned dismissal time. (i.e. leave and go sleep at home instead of the hotel.) 2.) Students are required to ride the buses to and from the hotel. (i.e. not with parents/friends) 3.) Students will abide by all rules given by any hotel staff, chaperones, volunteers, or Dallas Bay staff. 4.) Students will respect each other s personal property. 5.) Students will respect Dallas Bay Church s property. 6.) Students will dress in a way that honors themselves and God. Parent/Gaurdian: Student: Date:

3 MINOR ACTIVITY REPORT Minor s Information Minor s Name: Male ( ) Female ( ) Address: City: Zip: Date of Birth (mm/dd/yyyy): Current Grade: Parent/Guardian Information Parent/Guardian Name: Home/Cell Phone: Address: City: Zip: Emergency Contact & Medical Information Emergency Contact Person: Physician Name: Contact Phone Number: Contact Phone Number: Medical Problems/Allergies/Food Restrictions: Medications taking: Tetanus Inoculation Date: Activity restrictions, if any: Health Insurance Information Health Insurance Company: Policy Number: Group Number: Insurance Company Phone Number: PARENT/GUARDIAN PERMISSION I, the undersigned, being the parent(s) or legal guardian(s) of the minor named above, give permission for our minor to attend, participate in and/or be transported to/from Girls Conference 2019 sponsored by Dallas Bay Church from April 5th through April 6th. I certify that my minor is physically fit and adequately prepared to participate in this event. I further acknowledge that any activity restrictions or event, I do no wish for my minor to participate in; I have indicated by my initials in the Activity Participation Section below. MEDICAL TREATMENT AUTHORIZATION Risk Management 1 Church Security 360 Degrees, LLC

4 In consideration of Dallas Bay Church granting the minor permission to participate in Girls Conference 2019, I hereby assume all risks of her/his injury (including death) that may result from any program activity. As parent/guardian I do hereby release and agree to indemnify, defend and hold harmless Dallas Bay Church and its officers, employees, agents and all participants in the program from and against all liability including claims and suits of law or in equity for injury (fatal or otherwise) which may result from any negligence and/or my minor taking part in program activities. I certify that within the past year the minor has had a physical examination and that she/he is physically able to participate in all activities. In the event of injury or illness, I hereby give my consent for medical treatment, and permission to program staff for supervising and performing, as deemed necessary by staff, on-site first aid for minor injuries, and for a licensed physician to hospitalize and secure proper treatment (including injections, anesthesia, surgery, or other reasonable and necessary procedures) for the minor. I agree to assume all [costs] related to any such treatment. I also authorize the disclosure of medical information to my insurance company for the purpose of this claim. I understand as the parent/guardian of the minor, I must provide my own medical insurance for the minor. I understand that I am responsible for any medical or other charges related to the minor s attendance at the Girls Conference LIABILITY RELEASE In consideration of my child/minor being allowed to participate in Girls Conference 2019 and other valuable considerations the receipt of which is acknowledged, I hereby agree to the following: (I), the undersigned, do hereby release, forever discharge and agree to hold harmless Dallas Bay Church, its directors, employees, volunteers and agents (collectively herein the Church ) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever, which may be incurred by the undersigned and the Participant(s) while involved in Girls Conference Furthermore, we or (I) on behalf of our (my) child/minor hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation Girls Conference 2019 involved therein. The undersigned further hereby agree to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant(s), including expenses incurred attendant thereto. PHOTOGRAPH WAIVER I give consent for my child/minor to be photographed, videotaped or filmed while participating in for the resulting images to be used by Dallas Bay Church for promotional purposes. I give consent I do not give consent Signature of Parent/Guardian: Printed Name of Parent/Guardian: Date Signed: Risk Management 2 Church Security 360 Degrees, LLC

5 ACTIVITY LIST (PLEASE INTIAL NEXT TO ACTIVITIES YOU DON T WISH YOUR CHILD/MINOR TO PARTICIPATE IN) Patents Initials Activity/Event **************************************************************************************************** NOTARY PUBLIC State of Tennessee County of Hamilton This record was acknowledged before me on (date) by (name(s) of individual(s). Signature of notarial officer: Stamp Title of office My commission expires: Risk Management 3 Church Security 360 Degrees, LLC