D-Now 2025

Name

This address will receive a confirmation email

Phone

Address

School

Grade

6th 7th 8th 9th 10th 11th 12th Adult Sponsor

Gender

Male Female

Who Invited You?

Things We Should Know (Allergies, Medications, Etc.)

Disclaimer/FYI

Payments are due by March 7, 2025 Completed Medical Release Form. Check this box if you permit us to use digital images (photos) of your teenagers for social media, advertising, and/or video production for the Student Ministry and Broadway Baptist Church.

Medical Release and Permission: I give permission for my child to join Broadway Baptist Church for their D-Now weekend March 7-9. I do hereby verify that the information is correct and grant permission for the church to obtain medical attention in case of sickness or injury to my student. I also grant permission for an attending physician or hospital to perform whatever care deemed necessary by the church for the welfare of my student until you are able to reach me personally. I also release, absolve, indemnify, hold harmless, and forever discharge the church, the organizers, sponsors, and supervisors from any and all claims, demands, actions, or cause of actions, past, present, or future arising out of injury or damage while participating in this event. I assure all risks and hazards incidental to the conduct of the activities and transportation to and from the area. In case of the injury to my student, I hereby waive all claims against the organizers, the sponsors, or any supervisors appointed by them. I likewise release from responsibility any person transporting my student to and from the activities. I agree to provide medical insurance for my student.

Yes

Parents: If you would like to volunteer in some capacity, let us know. We will be in touch.

Yes No

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

D-Now 2025

Description

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