JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
THE BLITZ
IMPORTANT: Student must also have a DEFY Jump Park waiver filled out online from the link below..
https://haveablast.roller.app/planet3duluth/waiver/?_gl=1*x2nnch*_gcl_aw*R0NMLjE2MzgzMTQ4MzMuQ2owS0NRaUF0SmVOQmhDVkFSSXNBTkpVSjJGbE1fazlCallYdmhGc2NmQVROdHdsN1NWRGVldWNmbHp5SmZCUzQ4cTBicXlpVjQ2Wl9OQWFBaDV5RUFMd193Y0I.#/
THE BLITZ
When: January 7-8th
What: The Blitz is an all night, multi-site youth event that is hosted by Momentum Youth Ministries at Duluth Gospel Tabernacle.
Cost: If registered by December 19th - $65, If registered after December 19th - $75
(payments to be made at the doors during registration)
Schedule: 7 PM to 7 AM
Registration at DGT (6:30 - 7:00pm)
Concert/Raffle at DGT (7:05 - 8:00pm)
Defy Jump Park (8:20 - 10:10pm)
Adventure Zone (10:30pm - 12:45am) *pizza included here
Movie at DGT (1:15 - 3:30am)
Bowling (4:00 - 5:55am)
Breakfast at DGT (6:30 - 7:00am)
We'll provide snacks and soda/water throughout the night for all students.
Sign in to Google
to save your progress.
Learn more
Have you filled out the DEFY Jump Park waiver yet?
Yes
I will right after this form!
Clear selection
Today's Date:
Your answer
Your name and relation to student(s):
Your answer
First and last name of student(s) attending:
Your answer
Emergency Contact 1 (name and relation to student):
Your answer
Emergency Contact 1 (phone number):
Your answer
Emergency Contact 2 (name and relation to student):
Your answer
Emergency Contact 2 (phone number):
Your answer
Please provide the insurance information and policy number for your student(s):
Your answer
I agree to pay $65 or $75 (according on the date I am registering):
Yes
No
Other:
Clear selection
I understand that, in the event that medical treatment is required, every effort will be made to contact me and my emergency contacts, however, if I cannot be reached, I give permission to Momentum adult leaders to secure the services of a licensed physician to provide the care necessary, including anesthesia, for my child's well-being.
Yes I do agree to this.
No I do not agree to this.
Clear selection
I will allow my student(s) to attend 'The Blitz' overnight from January 7th to January 8th, which includes transportation throughout the night and activities at multiple venues - all listed in the event description above.
Yes
No
Clear selection
Thank you for registering your student! Please type your name as an electronic signature to legally approve your answers on this form.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
