Youth Event Registration Form

2025 Stand to Reason's Reality Student Apologetics Conference

March 21-23, 2025

Downingtown, PA

Please complete this form and click submit.

If you have any questions, please contact Mya Swart at 609-707-2502.

Teen's Name

Birthdate: (please include year)

Parent(s)/Guardian(s) Name

Email:

This address will receive a confirmation email

Phone:

Address

Best number to contact you during the event in case of an emergency?

Emergency Contact Name:(if you are unreachable):

Emergency Contact Telephone Number:

Insurance Company Name:

Insurance Member Number

Any allergy, medical or special needs information we need to be aware of?

Yes No

If yes, please describe:

RELEASE/DISCLAIMER: I do hereby assume full responsibility for any and all damage, injures (including death), or losses that my child may sustain or incur, if any, while attending, practicing, participating, or witnessing in any program, sport or physical activity occurring in or about the Columbus Baptist Church premises or at any off site location. I hereby assume full risk, waive all claims and release and hold Columbus Baptist Church, its instructors or partners of said program or event, individually or otherwise, harmless of any and all claims for injures or damages. I am fully aware and understand that the church does not have on or about the Columbus Baptist Church premises or employ or contract with any medical services, provision for ordinary or emergency medical services. In consideration of my child's participating in the use of the Columbus Baptist Church facilities, I hereby release and covenant not to sue the Columbus Baptist Church, it's owners, shareholders, directors, officers, employees, representatives, agents, and lessees from any and all claims resulting from any physical injury that may occur to child while participating in any program or event sponsored by Columbus Baptist Church. I have read and fully understand the above Release/Waiver and fully understand that I have given up substantial rights by signing this waiver voluntarily.

Agree Disagree

MEDIA CONSENT: I give my consent and permission for the taking of photographs and/or video of my child during the event and waive and/or assign any and all rights (including copyright) in such media to Columbus Baptist Church for promotional use in print and online. Columbus Baptist Church will not use their full names with the picture of the students on any media outlet related to Columbus Baptist Church.

Agree Disagree

Description

3/21-3/23, 2025

Youth Event Registration Form

Description

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