DNOW 2024 • East Ellijay Baptist Church, Inc.

To register click here. For payment click here.

Date

March 14, 2024 - March 18, 2024

266 out of 300 remaining tickets available

Type

Quantity

Student

266 Remaining

Quantity

Student 0

Register a Student

Please enter the following about your student.

First Name

Last Name

Gender

Date of Birth

School Grade - Current

Please list one or two students your child would enjoy staying with during DNOW. Note that this is not a promised housing assignment, but an opportunity to show preference.

Please list any known allergies or necessary medications below, and how/if someone will need to administer the medicine.

Insurance Information

Policy Number

Insurance Provider

Parent and Emergency Contact Information

Please provide the following for the student's emergency contact and guardian.

Parent Name

Email Address

Phone Number

2024 Release of Liability and Photography Disclaimer - Valid thru March 14,2025

As the Parent/Guardian,

I hereby grant consent for my student to go on and participate in sponsored activities and events with East Ellijay Baptist Church, under the supervision of its adult leaders provided by the church, and to travel in church provided, or chaperone vehicles, when necessary.
I further authorize the leaders to act on my behalf in the event of an emergency if it is not possible to contact us for some reason. It is not my desire that any needed medical attention be denied my child, or be delayed if to do so would jeopardize his/her best health interest because of an inability to make contact with us.
By affixing my signature below, I do hereby agree to hold harmless and indemnify East Ellijay Baptist Church of Ellijay, Ga Inc. and all agents and representatives from any and all claims of losses, injuries or damages, that may result from my child's participation in any activity or event sponsored by East Ellijay Baptist Church, and I further agree to waive any rights of legal action against East Ellijay Baptist Church, its employees, or agents.
To the best of my knowledge, the insurance and medical information listed here is correct, current, and complete. I agree to complete a new form in the event there are any changes in contact, medical, or insurance information.
I understand that my child may be featured in event photography or videography and this may be shared on social media platforms or displayed in a church service.
I understand that this form is valid thru March 14, 2025.

By typing my full name below, I agree that it is a legal representation of my manual signature, and that I agree to the above statements concerning my child/dependent and East Ellijay Baptist Church.

Please type your name in the space below to agree to these statements.