DNOW 2025 Registration Form

Student Information

Name

Birthday

Grade

School

This address will receive a confirmation email

Phone

Address

Parent Information

Name

Address

Phone

This address will receive a confirmation email

Alternate Emergency Contact

Phone

Address

Consent Forms

I hereby consent to participation by my child in the DNOW 2025 event. I fully understand that this event may take place away from the church grounds and that my child will be under the supervision of the designated staff and/or volunteers on the stated dates. I understand that such an undertaking involves an element of risk. I assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify, and agree to hold harmless Pleasant Hill Church of Florence and its agents from any and all liability that may arise out of participation in this event.

I do consent. I do not consent.

I give consent for emergency medial treatment if necessary, as determined by the trip chaperones. I agree to hold harmless and release Pleasant Hill Church of Florence and its agents from any and all liability related to expensesarising from the giving of such medical care. As parent/legal guardian, I remain fully liable for any legal responsibility which may result from any personal actions taken by the named participant.

I do consent. I do not consent.

I hereby grant permission to Pleasant Hill Church of Florence to use my child's likeness on its promotional materials including, but not limited to video, websites, social media and printed materials without further consideration, and I acknowledge Pleasant Hill Church of Florence right to crop or treat the likeness at its discretion.

I do consent. I do not consent.

Payment

Deposit

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

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DNOW 2025 Registration Form

Description

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