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Clayton Event

August 14, 11:00 a.m. – 3:00 p.m.
Pinnacle Retreat Center
200 Adventure Lane
Clayton, Georgia 30525

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OneDay FunDay Registration

OneDay FunDay Clayton Registration

Registration is required to attend the event. Deadline to register is August 6. Limited capacity - register early! OneDay FunDay Clayton is provided by Mission Georgia of the Georgia Baptist Mission Board. Mission Georgia is collaborating with Place of Hope North Georgia to bring this event. If you have any questions, please contact: Elizabeth Adams at execdir@placeofhopenga.com or (706) 982-1343.

Fields marked with an * are required
Instructions: This form must be completely filled out. The information is vital to the health and well-being of the child.

PARTICIPANT REGISTRATION

Participant Name
Participant Name
First
Last

PARTICIPANT REGISTRATION

PARTICIPANT REGISTRATION

PARTICIPANT REGISTRATION

PARTICIPANT REGISTRATION

PARTICIPANT REGISTRATION

LEGAL GUARDIAN INFORMATION

Legal Guardian’s Name attending OneDay FunDay with children listed above:
Legal Guardian’s Name attending OneDay FunDay with children listed above:
First
Last
Legal Guardian Address
Legal Guardian Address
City
State/Province
Zip/Postal

Medical Information

Medical Insurance Coverage
I acknowledge that neither the Georgia Baptist Mission Board, Place of Hope North Georgia, Inc. nor GBWMU of Georgia shall provide medical insurance coverage for myself or the children I am bringing to OneDay FunDay. I acknowledge that all information provided on this registration is current and correct.

Medical Release
This health history is correct so far as I know, and the above named minor has permission to engage in all prescribed program activities, except as noted. The undersigned do hereby authorize the directors of Pinnacle Retreat Center/Place of Hope North Georgia/Mission Georgia or such substitute as they may designate as agent for the undersigned to consent to an X-Ray examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care for the above minor which is deemed advisable by and to be rendered under the general or special supervision of any physician and surgeon, licensed under the provision of the Medicine Practice Act or any dentist licensed under the Dental Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital, camp or elsewhere. This authorization will remain effective while the above minor is enroute to and from or involved or participating in any camp program, unless revoked in writing by the undersigned and delivered to the Director of Pinnacle Retreat Center/Place of Hope North Georgia/Mission Georgia as legal guardian/social worker/other. I give my permission for the Participant to attend a Pinnacle Retreat Center/Place of Hope North Georgia/Mission Georgia event on August 14, 2021.

Other
I expressly agree that this content and release is intended to be as broad and inclusive as permitted by the laws of the state of Georgia in the United States of America., and that this release shall be governed by and interpreted in accordance with the laws of the State of Georgia. I agree that in the event that any clause or provision of this release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this release, which shall continue to be enforceable. This release shall be governed by and construed under the laws of Georgia.

I agree that any legal action or proceeding relating to this release as a result of myself or children listed in my care participating in the OneDay FunDay event shall be brought only in Rabun County, Georgia.

Verification *
I agree that providing the requested information and checking this box is the same as having signed my name.

Parent/Guardian Digital Signature

By filling out your name and today's date below, you are providing a digital signature. You are acknowledging that all of the information provided is accurate and affirming that you have the legal right to provide this information on behalf of the child as their parent or legal guardian.

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for children or youth work. In consideration of the receipt and evaluation of this application to be a OneDay FunDay volunteer, I hereby release any individual, church, youth organization, charity, employer reference, or any other person or organization, including record custodians, both collectively and individually from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.

I also understand that I am consenting to my personal image being used in media such as still pictures and videos for the possible use of future social media, online, training, or reporting related to Mission Georgia, OneDay FunDay, the Georgia Baptist Mission Board and partnering organizations.

I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understand.

Applicant Verification *
I agree that providing the requested information and checking this box is the same as having signed my name.

Program Participation Agreement for OneDay FunDay

I, the undersigned, hereby acknowledge that the children listed in my care and myself are able to participate in OneDay FunDay. It is my wish for the children listed above to participate in any and all activities.
I release and forever discharge and hold harmless the sponsors, organizers, volunteers, and property site owners, specifically including, but not limited to Georgia Baptist Mission Board, Place of Hope North Georgia, Inc. and GBWMU of Georgia, as well as their affiliates, directors, officers, trustees, administration, and employees from any and all liability, claims and demands of any kind which arise or may hereafter arise from participation in the OneDay FunDay event. This release specifically includes, but is not limited to, any claim for negligence or negligent acts or omissions and any present or future claim, loss or liability for injury to person or property that I or the children listed in my care may suffer, which arises out of mine or those I have listed for participation during OneDay FunDay.

Once you submit this registration application, you will receive an email confirmation and a copy of your information. Your browser will also be redirected back to the Place of Hope North Georgia page.