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5th Grade C3 Youth Night on Wednesday, April 23, 2025 @ 6:00 PM

$0.00
Put the Student's name in for the "Attendee Information." If you login, you may be able to choose your student from the drop-down and your information will auto-populate for the Parent/Guardian Information. Please register each child separately.
Tell us how many to expect. We do ask that it be only graduating 5th grade students and their parents.
$0.00 
List the first and last name(s) of the parent(s) or guardian(s) that will be attending with the student.
*Student's Birthday:
*Student's Gender
*Parent or Guardian (First & Last Name):
*Parent or Guardian Phone # (555-555-1234):
*How many will be in attendance?:
I understand that there are inherent risks involved in any ministry activity, and I hereby release the Central Christian Church and its ministries, hereafter known as the Church; its employees, agents, and volunteers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of the participant’s involvement. I give the employees and/or representatives of the Church permission to authorize emergency medical and dental treatment. In the event that the named participant is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that I will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. 

This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Church, its employees, agents, and volunteers of any liability against personal losses to the participant.
Central Christian Church and its ministries may use photos, videos, or statements from this event in church-created publications, media releases, information displays, websites, social media, and/or other electronic media. No personal address, phone number, or email address will be included. If you prefer to not be included for any reason, please communicate this to the ministry leader or our Communications Director, Craig Sephton.
*Typing your name below provides documentation of agreement with the above statements and will be considered your official signature.
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