Event registration
When: Friday, November 3 - Saturday, November 4
Where: We will meet at the church garage parking lot at 3:45 pm Friday, November 3 and depart by 4:00 pm. We will return to the church garage parking lot by Saturday, November 4 at 8:00 am
If you have any questions please contact Pastor James at (304) 920-5005 or jwalsh@johnstonchapel.org
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Student's Name *
Student's Email
Parent's/Guardian's Email *
Parent's/Guardian's Phone Number *
Secondary Emergency Contact Phone Number (We will contact main parent/guardian first) *
Dietary restrictions *
Allergies/Important Medical Information *
Berglund Center Ice Waiver Form
Please click on the link above, print out the waiver form and have your child bring the completed form with him or her on the night of the event. This gives your child permission to play games on the ice during the rally.
Launching Pad Waiver Form
Please click on the link above, print out the waiver form and have your child bring the completed form with him or her on the night of the event. This gives your child permission to participate at the trampoline park.
I understand that I will have to pay $65 if registered by October 2 and $70 if registered afterwards upon arrival. *
Required

I give permission and I fully understand that my son/daughter is participating in activities sponsored by Johnston Chapel Baptist Church. I will not hold Johnston Chapel Baptist Church, any of its agents, assigns, employees, or volunteer sponsors (hereafter all referred to as sponsors) liable for any accidents, injuries, or any other unforeseen harms incurred at any time while participating in this activity, except in the case of gross negligence. I authorize Johnston Chapel Baptist Church and its sponsors to find adequate and reasonable medical treatment at my expense, if the need arises.

This waiver will serve as a medical release form, thus authorizing the sponsor permission to act on my behalf until such a time that I can be contacted.

I understand that by signing below, as the parent/legal guardian, I grant permission for my child to participate in this activity (Signing below does not nullify your rights granted to you by local, state, and federal laws). I also understand that my child will not be allowed to participate if they are not accompanied by this completed form before the activity begins.

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