Rescue New Orleans February 1-5, 2008

REGISTRATION & DISCIPLINE - MEDICAL RELEASE FORM

Simply fill in the blanks on this form.
When you are done, print the completed registration document and have it notarized.

You may fax it to: (404.627.2050)
or mail the document along with your payment to: Rescue Atlanta - POB 965039 Marietta, GA 30066

Keep a copy of the completed registration pages for your records.

The total registration cost is $199 - REGISTRATION DEADLINE INCLUDING PAYMENT IS MONDAY January 21, 2008
Should miss the registration deadline PLEASE CONTACT OUR OFFICES IMMEDIATELY.

We want to make room for you if we can!

FOR ADDITIONAL INFORMATION CALL OUR OFFICES @ (404) 627-0054




 

 
What is your first name?

What is your last name?

What is your e-mail address?

Date of birth?

Address?

City?

State?

Zip code?

Home phone?

Daytime contact phone?

Name of home church?

Pastor's name?

T-Shirt Size?


Our Outreach Team will have the following ministry available:
(Check all that apply)

Praise & Worship
Puppets
Clowns
Instruments

Please list type of registration, Individual or Group:
Individual Registration
Group Registration
Number of people in the group:
Please list below any other skills and/or ministry
that you and your team will have available:
Please select all that apply to you below:

As leader of our group accept the responsibility for the discipline, motivation and behavior of our group.I agree that if any one of our group members are sent home, it will be at his or her own expense with my approval.

I am an adult (18 years or older) and give my consent for the DIRECTOR or properly appointed staff member of “Rescue Atlanta”, to secure the administration of medical treatment or medication for myself in case of emergency, and I do further agree to pay for the performance of such treatment, anesthetics, and operations as in the opinion of the attending physician is deemed necessary for myself or the above minor.

I am the parent of said minor, do give my consent for the DIRECTOR or properly appointed staff member of “Rescue Atlanta”, to secure the administration of medical treatment or medication for the said minor in case of emergency, and I do further agree to pay for the performance of such treatment, anesthetics, and operations as in the opinion of the attending physician is deemed necessary for the above mentioned minor.

I, being an adult (18 years or older), hereby release “Rescue Atlanta”, it’s agents, assigns, employees, and volunteer assistants from any liability whatsoever arising out of injury, sickness, or damage which may be sustained by myself during the course of travel to, during, from, and on any site or premise of “Rescue New Orleans 2008”.

I, the parent of said hereby release “Rescue Atlanta”, it’s agents, assigns, employees, and volunteer assistants from any liability whatsoever arising out of injury, sickness, or damage which may be sustained by the above said minor during the course of travel to, during, from, and on any site or premise of “Rescue New Orleans 2008”.
(You may now print the pages to be notarized)