Registration - Spiro First Baptist Church

D-Now Registration Form

How many students are you registering?

Just one

More than 1

Please list their names and ages here.

Student Age

Address

City

State

Zip

Parent/Guardian Emergency Contact Name

Parent/Guardian Contact Ph#

Secondary Emergency Contact

Second Emergency Contact Ph#

Does your student/students have any known food/medication allergies or medical conditions? (Example - Epilepsy, Peanut Allergy)

Please Explain

Does your student/students require daily medications or inhaler, insulin etc?

Please Explain

It is the policy for this event that the responsible party dropping the student off at the event should be the party responsible for picking the student up at the conclusion of the event. If for some reason the person picking the student up will differ from the person who dropped them off, please click yes below and provide the information for the person who will be picking up the student. If you answer no, the student will only be released to the person who dropped them off.

Yes

Please list their name and phone# here.

I hereby authorize Spiro FBC and it's representatives to act in my place in the event of a medical emergency and to make medical decisions up to and including initiating emergency medical treatments, first aid, calling an ambulance and transporting my student/students to an emergency department.

I Agree

I hereby give my express permission to Spiro FBC to record myself and or my student/students in digital media to be used for promotions in current or future events. I understand that my picture or video may be taken and published to the church website and/or social media platforms.

I Agree

I understand that if my student/students drives themselves, they will be required to check their keys with event staff upon arrival at the event and will receive them back at the end of the event. Students will not be allowed to leave the event except in an emergency situation.

I Agree

I, being the parent or legal guardian of the student/students named above, do hereby consent to the participation of my youth in all the scheduled youth activities at Spiro FBC Youth Ministries, and any other supervised activities customarily associated with its youth group, including youth rallies and overnight or weekend youth trips. Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational and sporting events. I hereby release Spiro FBC and all of it’s staff/volunteers from any and all legal liabilities for any injuries or damages incurred as a result of participation in these activities. If I wish to revoke this consent for any reason, I will promptly notify the youth leader in writing.

I Agree

Parent/Guardian E-Signature

As soon as you click on the Register For D-Now button below, you will be directed to the pay portal to pay for your student/students. The student fee is $40 per student if paid by April 19th. After April 19th the fee is $55 per student. Simply enter the total for your student/students and select "D-Now" from the drop down menu in the pay portal.

I agree