Event Registration

Back to Event Detail

Phoenix Mission Trip Spring Break 2022 on Sunday, March 13, 2022

ATTENDEE INFORMATION
*Birthdate:
*Gender
*Campus you attend
PARENT OR GUARDIAN INFORMATION

Students between the ages of 10-15 must be accompanied by a parent.  Please complete the following,  ONLY if you are registering a student between 16-18 who will be traveling without a parent

*Guardian First Name:
*Guardian Last Name:
Guardian Email:
Guardian Phone:

Please list any medical conditions or medications your student is currently taking. 


Please list any food allergies or dietary restrictions for your student.

Please send a copy, front and back,  of your student's medical insurance card to ashley.fox@rollinghills.church



*
Medical Release


I, the undersigned, as the legal guardian of the above named Attendee, authorize the Designated Agents (as hereinafter defined) of Rolling Hills Community Church, 1810 Columbia Avenue, Franklin, Tennessee 37064 (the “Church”), to consent to, and to execute any and all documents necessary for my child (or for an adult leader, if completing for yourself),  to be treated by a medical doctor or a medical facility, whether on an emergency or non-emergency basis, if such care be determined necessary for his or her care, health and general welfare during any activity or event associated with the Church. 

For purposes of this Medical Authorization and Release, the “Designated Agents” are defined to be the following: Nic Allen

Those persons identified as adult counselors and sponsors for an activity or event associated with the Church in an affidavit executed by any of the individuals listed above and presented with this Medical Authorization and Release at the time medical treatment is requested for the above-named Attendee.

This authorization shall remain in effect, from this date until 11:59pm March18, 2022, unless sooner revoked in writing by me. I hereby release Rolling Hills and the Designated Agents from any claims, liabilities, demands, damages, rights and causes of action resulting or arising, directly or indirectly, from any consent or action taken by him or her pursuant to this Medical Authorization and Release.

*
Adult's Signature (type in):

*
Date:




*
Accident Waiver & Release of Liability


I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH HIGH SCHOOL MISSION TRIP, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. 


I certify that I am physically fit and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity. 


I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. 


In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: 
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Rolling Hills Community Church, (RHCC) and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; 
(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. 


I acknowledge that RHCC and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. 


I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. 


The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. 

*
Adult's Signature (type in):

*
Date:




*
Photo Release Agreement


I give Rolling Hills Community Church permission to use my child's likeness in a photograph, video, or other digital media in any and all of its publications, including web-based publications, without payment or other consideration.
Rolling Hills Community Church will only use photos and video from High School Mission Trip privately: for internal publications, internal promotion of future mission trips, and on our Rolling Hills social media accounts.