Great Day of Service – April 7, 2019 | First Baptist Church Ponca City

2019 Great Day of Service Sign-up

Please complete one form per adult/student invovled.

Step 1 of 2

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Name*
First Last
Email*
Phone*
(Best number to reach you)
Emergency Contact*
First Last
Emergency Contact Phone Number*
Child Care
Name Age (Birth - 5 yrs)

Childcare will be offered at your Church for children ages Birth-5 years. Please list the names and ages of your children that will be in the Nursery. Click the plus sign to add more than one child.

T- Shirt Size*
Project Preference*
*Flexibility is appreciated.
Age Range*
Youth Liability Release*
- I Agree
By clicking "I Agree" you consent to the following:We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray exam- ination; anesthetic: medical, surgical, or dental diagnosis or treatment; and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Furthermore, we (I) hereby assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees, and agents, for any liability sustained by said church as the result of the negligent, willful or intentional, acts of said participant, including expense incurred attendant thereto. The undersigned does also hereby give permission for our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by First Baptist Church, Ponca City, OK.
Name of Parent or Guardian agreeing to the Youth Liability Release*
Adult Liability Release*
- I Agree
By clicking "I Agree" you consent to the following: I desire to participate in the Great Day of Service (April 7, 2019), and as a part of that participation, I agree to the following: I release from responsibility and forever waive any right I have for any action or any claim of any sort, including but not limited to: any personal injury, property damage, or wrongful death, whether known or unknown, against First Baptist Church of Ponca City or any of its employees, representatives, agents, or volunteers (collectively referred to as “Releasees”) that might occur as part of participation in this project. I further indemnify and hold harmless the Releasees from any claim or litigation for compensatory or punitive damages, included but not limited to: judgments, assessments, and/or attorneys’ fees arising out of participation in the Great Day of Service project. I understand this Agreement is continuing in nature. I agree to it knowingly and voluntarily, and without duress or undue influence. I give First Baptist Church of Ponca City and any person acting under its authority permission to publish, distribute, broadcast, license, copyright, promote, and sell any form of visual, print, or audio recording of my participation, including application of any visual or auditory special effects. I release any claims of copyright or ownership, and agree that these materials may be duplicated or distributed with or without compensation or liability, in perpetuity. I understand that First Baptist Church of Ponca City is obtaining this release and assignment of copyright in order to conform to U.S. copyright laws and international copyright treaties and conventions.
Comments

Name	Age (Birth - 5 yrs)