Middle School Retreat Weekend
* First Name
* Last Name
* 2026-2027 Youth Grades
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6th
7th
8th
9th
10th
11th
12th
* Gender
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Male
Female
* Parent Name
* Email
* Parent Phone
* Insurance Company
* Ins. Phone #
* Ins. Address
Release of Liability and Medical Consent
I hereby waive, release and forever discharge anyone all claims, rights, and causes to action of whatsoever kind or nature for myself, my heirs, executors, and administrators against FBC and other sponsors, their agents, servants, officers, employees, directors, representatives, and assigns for injury or illness (including COVID or otherwise) which may directly or indirectly result from my participation in the FBC event, trip activity, or meetings and I further agree to save hold said parties harmless and agree to indemnify each of said persons against all liability for any loss, cost, injury, or damage to persons or property which may arise by virtue of the undersigned engaging in FBC events, activities, trips and meetings. I further state that my child is in proper physical condition to participate in the event. I recognize the sponsors of the event have not undertaken to provide the undersigned with any medical care, treatment or advice concerning my child’s participation in this event. By signing below, I understand the information above and the risks involved in the activity my child/student will be undertaking.
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