2026 Southeast 5th Grade Conference Registration Form

Adult Release of Liability
I do hereby release, forever discharge, and agree to hold harmless The Churches in Athens, Atlanta, Kennesaw, Birmingham, Knoxville, Nashville, Murfreesboro, Memphis, Chattanooga, Simpsonville, Columbia, Charlotte, Chapel Hill, Raleigh, Jacksonville, Gainesville, Fort Myers, Fort Lauderdale, Tallahassee, Boca Raton, Miami, Tampa, and Orlando; their staff; and volunteers (collectively, “Indemnitees”) from any liability, claims, or demands for 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 that occur while that participant is participating in the above described activity.

Furthermore, I assume all risk or personal injury, sickness, death, damage, and expense as a result of participation in transportation, recreation, and activities involved therein.

The undersigned further hereby agrees to hold harmless and indemnify the Indemnitees, their representatives, directors, employees, and agents, for any liability sustained by the church as the result of the negligent, willful, or intentional acts of the undersigned, including any expenses incurred.
Adult name
Signature*

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MEDICAL RELEASE FORM
Name of child
I, the parent or guardian of the aforementioned child, authorize the bearer of this document to obtain any and all medical and/or emergency care which in the bearer's opinion is needed by my child. I also accept full responsibility for the payment of any expenses incurred from such medical and/or emergency care.
Parent/guardian name
Parent/guardian signature*

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Parent work phone*
Format: (000) 000-0000.
Alternate contact name*

First NameLast Name
Alternate contact phone*
Format: (000) 000-0000.
Name of child's physician*
Physician's phone*
Format: (000) 000-0000.
Child's insurance company*
Policy or Group*
Current medications, allergies (please repeat the ones you may have mentioned earlier in this form), or health problems we should know about:*
Write N/A if none

Child Release of Liability
Name of child
I, the parent or guardian of the above-named child (“participant”), hereby release, forever discharge, and agree to hold harmless The Churches in Athens, Atlanta, Kennesaw, Birmingham, Knoxville, Nashville, Murfreesboro, Memphis, Chattanooga, Simpsonville, Columbia, Charlotte, Chapel Hill, Raleigh, Jacksonville, Gainesville, Fort Myers, Fort Lauderdale, Tallahassee, Boca Raton, Miami, Tampa, and Orlando; their staff; and volunteers (collectively, “Indemnitees”) from any liability, claims, or demands for 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 that occur while that participant is participating in the above described activity.

Furthermore, I assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in transportation, recreation, and activities involved therein.

The undersigned further hereby agrees to hold harmless and indemnify the Indemnitees, their representatives, directors, employees, and agents, for any liability sustained by the Indemnitees as the result of the negligent, willful, or intentional acts of the participant, including any expenses incurred.
Parent/guardian signature*

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Important Information
ARRIVAL AND DEPARTURE: Arrival time and registration will be 6:00 p.m. to 7:00 p.m. on Friday evening. Please eat dinner before you arrive. The first meeting will begin at 7:00 pm Friday. The conference will end at 10:30 am on the Lord's Day.

WHAT TO BRING: Each 5th grader needs to bring a sleeping bag and pillow. Also bring personal toiletries, towel, Recovery Version of the Bible - Old and New Testament. Bring modest clothing for the meetings and sportswear for the recreation time. 5th graders - Do not bring: cell phones, tablets, or other electronic devices.

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5th grade conference registration

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Parent/Guardian/Serving One Registration