RECHARGE 2021: "UNSHAKEABLE"
Please complete this form to register for Recharge 2021: "UNSHAKABLE"
January 29-30, 2021 at Rock City Church in Baltimore, Maryland 21234  
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Last Name *
First Name *
Gender *
Churches *
Required
Church Address *
Senior Pastor *
Age *
Date of Birth *
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T-shirt Size *
Do you have one of these talents or skills? *
Required
What instruments do you play?
Do you have any allergies or dietary concerns? If "yes", complete allergy action plan separately. If "None" Type "None" below. *
Do you have any health concerns? If "yes", complete Health Inventory form separately. If "None" Type None below. *
Participant's Email *
Participant's Phone Number *
Youth Leader's Name *
Participant Address *
Parent or Guardian (First & Last Name) *
Parent or Guardian Phone Number *
Parent or Guardian Email Address *
Emergency Contact Name (First & Last) *
Emergency Contact Name (Relationship) *
Emergency Contact Phone Number *
Housing Preference *
Required
Rock City Church is authorized to approve first aid or medical treatment if necessary. *
Is the participant covered by family medical insurance? *
Name of Insurance Provider & Policy Number *
Physician Name & Phone Number *
How will you attend Recharge 2021? *
Required
Liability Statement: By typing your full name below, the participant (parent/guardian if the participant is a minor), acknowledges and accepts the risk of physical injury or illness associated with participation with Compassion Commission "Recharge." The participant also acknowledges that photography taken throughout the event can be used for promotional purposes. The participant accepts personal and financial responsibility for any bodily or personal injury or illness sustained during any activities at Compassion Commission "Recharge." Further, the participant (parent/guardian if the participant is a minor), promises to hold harmless The Rock City Church, Compassion Commission, its representatives, and partner organizations for any injury or illness related to all activities. It is agreed that all registration fees and housing fees are non-refundable for any reason. Please type your full legal name to acknowledge the acceptance of this liability statement. *
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