Student's Name *

First Name

Last Name

Student's Phone

(###)

###

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2nd Student's Name

First Name

Last Name

2nd Student's Phone

(###)

###

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Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian Phone *

In case of emergency or return time updates

(###)

###

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Release from Liability *

I will not hold Cornerstone Church, nor its leaders, nor its members, nor the owners of Clinton Sease Farms, liable for any bodily harm or damage that comes about as a result of this event. I will be contacted in the event of a medical emergency, and I will pay any/all costs of necessary medical treatment as a result of participating in this event.

Yes

Behavior Expectations *

My teen will abide by all behavioral expectations set by the leaders including (appropriate behavior in public places, no 'coupling' or going off as couples, no private 1-on-1s for youth or adults of the opposite sex, no foul language spoken or sung or played, etc.). If my teen will not cooperate I will be asked to drive and pick them up and take them home.

Yes, my student will follow instructions

First Aid *

I agree to any on-site first-aid that might need to be administered as a result of this event.

Yes

No