Live Pure: Girls Retreat Online Registration

Parent/Guardian Information

Emergency Contact

Insurance Information

Medical/Photo Release & Authorization

I, the undersigned parent/guardian understand that my child is responsible for knowing all the rules and regulations made by Southeast Student Ministries for all activities. It is expressly understood by the parents/guardians that the child for whom this registration is made is in a condition of health that warrants his/her participation in any event, and that the adult leaders of this activity are hereby granted permission to take the named youth to a medical doctor for examination and treatment of any accident or illness that may arise during any activity between the dates listed above. It is also understood by the parents/guardians that changes in the child’s Health History must be submitted in writing to Southeast Student Ministries. In consideration of this acceptance for said activities and said ministry, Southeast Christian Church, its staff, and volunteers are hereby released and relieved from all liability for accident and injury to said youth arising from any and all activities of these events. I understand Southeast Christian Church has all rights to work done by my child, including any poses, acts, plays, and appearances made by my child, as well as the right to use my child’s name and photographs, either still or moving, for commercial and advertising purposes in connection therewith.
        
I understand that this Medical Release & Photo Release will be EFFECTIVE FOR ALL TRIPS and EVENTS BETWEEN DECEMBER 31, 2011 AND DECEMBER 30, 2012.