Teen Week • Hope Chapel

Date & Time

June 3, 2024 6:00 PM - June 7, 2024 9:00 PM

192 out of 200 remaining tickets available

Type

Quantity

Teen Week

Quantity

Teen Week 0

Youth's Name

First Name

Allergies

School Grade

Last Name

Date of Birth

Are there any medical conditions we should be aware of?

Yes/No

Are you taking any medications? If so, please list and explain below.

Yes/No

Please indicate height and weight in the event emergency meds are needed.

Height

Weight

Parent/Emergency Contact

Preferred Name

Phone Number

Email Address

Who invited you to Teen Week at Hope Chapel?

Name

What is youth's t-shirt size?

Size

Church of regular attendance, if any:

Church

Please read the following waiver and type your name at the bottom to signify agreement:

-All tech (phones, smart-watches, and ear buds) will be turned in each day at check-in to avoid damage during the event. They will be returned at check-out.

-The information on this form is considered to be confidential and will only be shared with the Teen Week Director and Teen Week Leaders on a need to know basis to ensure the physical and mental health of your child.

-A parent consent waiver is required for participation and use of photography. Your signature on this registration will signify consent to the following.

I give Consent for ___________________________________________ (name of minor) to attend Teen Week at Hope Chapel held at the property of Pleasant Grove Baptist Church June 3rd-6, and the Page residence, 3927 Pennington Rd, Greer, SC on June 7th.

In the event that he/she is injured while under the care of Hope Chapel and its representatives and requires the attention of a doctor, I hereby consent to and will be financially responsible for any reasonable medical treatment as deemed necessary by a licensed physician. I understand I will be contacted immediately in the case of an injury requiring doctor intervention.

I further agree to hold the licensed physician, the medical facility, Hope Chapel, Pleasant Grove Baptist Church, Greg & Fonya Page, and their representatives free and harmless of any claims, demands, or suits for damages arising from the authorization and provision of such medical treatment.

While we understand that every precaution will be taken to provide a safe event for my child, I acknowledge the active nature of the planned events and do hereby release Hope Chapel, Pleasant Grove Baptist Church, Greg & Fonya Page, and their representatives from any liability due to accident or injury incurred by my child.

Name of minor waiver applies to:

Youth's name

Photographs/Video Consent

I/We give consent for photographs, videos and/or likenesses of my child attending Teen Week 2024 events hosted by Hope Chapel to be used for promotional purposes for Hope Chapel or on Hope Chapel's social media platforms.

Consent - Yes/No *

Please acknowledge the following:

To the best of my knowledge, my child is in good health.

Yes

I agree to reimburse Hope Chapel for any prescriptions or medical expenses incurred for this student.

Yes

In the case of a medical emergency, I understand that every effort will be made to contact parents or guardians. In the event I cannot be reached, I hereby give permission to the physician/nurse selected by the Teen Week Director to best treat my child.

Yes

Please type your name as an e-signature to indicate agreement with the above.

Signature *