EmailMeForm
SNOW TUBING REGISTRATION
Wednesday, January 19, 2022
Massanutten Snow Tubing Park
Cost is $25.00. Registration deadline is Sunday, January 16.
Meet at the church at 5:00 p.m. (bring bag dinner), and get picked up at the church between 8:30-8:45 p.m.
Complete this form, click submit, pay by credit card, OR if you'd like to pay by cash or check just close out of your browser. (LEADERS close out of payment page.) YOU'RE ALL DONE! You will receive a confirmation email.
If you're paying by cash or check, bring cash to the church office, or bring/mail check to the church office (make check payable to Covenant Pres. Church, mail to 32 Southgate Ct., Ste. 101, Harrisonburg, VA 22801).
Name(s)
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Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Email
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Total student(s) registered at $25.00 each (leaders free):
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Please select
1
2
3
4
Late arrival
I'll be arriving late & providing my own transportation.
I am willing to help with transportation and can drive this many students in my vehicle.
Health Insurance Provider
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Policy #:
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Any allergies and/or medical needs?
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Emergency Contact:
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Phone # of Emergency Contact:
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PLEASE READ, SIGN & DATE
I/We understand that there are inherent risks involved in any ministry or athletic events; and I/we hereby release the church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our involvement. In the event that I/we is/are injured and require the attention of a doctor, I/we 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/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that I/we 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. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the person(s) named above. I/We also agree to bring myself/ourselves home at my/our own expense should I/we become ill or if deemed necessary by the youth ministries staff member. This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the church and its staff of any liability against personal losses of above named person(s). I/We, the undersigned, have legal custody of the student(s) named above, a minor(s), and have given my/our consent for him/her to attend Snowtubing at Massanutten Resort on Wednesday, January 19, 2022.
Parent/Guardian Signature
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Clear
Parent/Guardian Signature
Clear
Date
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