Tennessee Christian Teen Convention

Please complete this registration form to get signed up. Only one form needs to be completed for each family that resides in the same household.

Guardian Name

Guardian Email

Guardian Phone

Street Address

City

State

Zip Code

Alternate Emergency Contact

Relationship

Telephone

1st Student Name

1st Student Phone

1st Student Birthdate

1st Student Shirt Size

1st Student Allergies or Special Notes

2nd Student Name

2nd Student Phone

2nd Student Birthdate

2nd Student Shirt Size

2nd Student Allergies or Special Notes

3rd Student Name

3rd Student phone

3rd Student Birthdate

3rd Student Shirt Size

3rd Student Allergies or Special Notes

I, the undersigned, being the parent or legal guardian of the youth(s) named above, do hereby consent to the participation of my youth in the Tennessee Christian Teen Convention January 7 - 9, 2022 facilitated by Encounter Life Ministries. Further, I certify that my youth is physically fit and adequately prepared to participate in this activity. I understand that every activity sponsored by this church is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforeseen events can occur. By signing this form, I agree to assume and accept all risks and hazards inherent in church related activities. I also agree not to hold Encounter Life Ministries or its employees or volunteer assistants liable for damages, losses, or injuries to the person or property undersigned.

In the event that I cannot be reached in an emergency during the dates specified on this form, I hereby give my permission to the physician or dentist selected by the church leadership to hospitalize, to secure proper treatment, and/or order an injection, anesthesia, or surgery for my son or daughter, as deemed necessary.

I understand that I am signing for the minor listed on this form and the signature is for both a medical and liability release.

My electronic signature and date below constitute my consent. I understand that I may submit a paper copy of this form in place of using an electronic signature.

Parent/Guardian Consent Signature

Date