Please fill out the following information. You will receive a confirmation email upon completion.

While at the retreat, who is the emergency contact?

All participants are expected to behave in a manner that is respectable to the staff/volunteers. Certain items and/or activities will not be permitted or tolerated and any person caught in violation of these rules will be sent home. Such items/activities include, but are not limited to: possession or use of alcohol, any immoral sexual behavior, illegal drugs, or tobacco of any kind verbal or physical abuse, or any other rules established by the staff/volunteers.

If the participant is a minor the Parent/Guardian must complete the section below.

I the undersigned parent/person having legal custody/legal guardian of the above-named minor give permission for the above named minor to participate in and travel with RBC on for the event for which we have registered for. I agree to provide transportation back home for the above named minor if he/she is found in violation of the above-listed rules.

I am confident that the volunteers/staff, will take appropriate care of me, or my child. However, I understand that accidents do occur, and in the event of an emergency, every effort will be made to contact me immediately. In the event the volunteers/staff is unable to reach the above emergency contact, I do hereby authorize an adult leader of the activity, as agent for me, to consent to any x-ray examination, medical, dental, or surgical diagnosis; treatment and hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor’s office or in any hospital. I also agree to reimburse any expenses not covered by the church’s insurance.

I, the undersigned participant, parent and/or guardian of said participant, do hereby waive and release, indemnify, hold harmless and forever discharge Rileyville Baptist Church and its agents, employees, and volunteers, of and from any and all claims, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or in equity, that I ever had or may have, arising from or in any way related to the participation of the above participant in any of the event, transportation to and from, and/or any other activities related to Rileyville Baptist Church, provided that this waiver of liability does not apply to any acts of gross negligence, willful, or wanton misconduct.

All deposits made after December 1st are non-refundable.