WHEN, WHERE, AND HOW MUCH? When: Friday Feb 4 @ 6:30PM – Sunday Feb 6 @ 12PM Where: in host homes all over Cypress COST: $45
WHAT IS IT? Premiere Weekend is the most incredible weekend of the year! High School and JHigh students will gather in host homes all over the Houston area for an incredible time of fun, friendships and discussion. Each evening students from all five of our campuses will come together for an amazing worship service with talented guests. The worship, small group times and activities will make this event one powerful weekend in the lives of our students.
WHAT TO BRING WHAT NOT TO BRING Bible and pen NO drugs, alcohol, cigarettes, tobacco, etc. sleeping bag, pillow NO inappropriate clothing casual clothes NO fireworks OR weapons tennis shoes NO stuff you think you probably shouldn’t bring… towel be smart toiletries
IMPORTANT TIMES Friday, Feb 4th SUNDAY, Feb 6th Check in at 6:00PM in the west parking lot of Berry Parent Pickup will be @ 12PM at Berry Center Center We will eat dinner on busses en-route to the North campus for Worship. We will depart on busses for North at exactly 6:30PM Please don’t be late!
EMERGENCY NUMBERS Second Baptist Church Dispatch: 713-365-2327 Rachael Jones : 806-570-2976 Premiere Weekend Registration February 4-6, 2011
Student’s Name______Grade _____ School______Date of Birth______One friend I would like to be in the same house with at Premiere Weekend ______Address ______
City/St/Zip ______(Circle One) Male/Female
Father’s Name______Mother’s Name______
Home Telephone______Home Telephone______Cellular Telephone______Cellular Telephone______
Payment Information Cost $45
Payment Type (Circle One) Check (ck#______) Cash
Please attach payment to this form when turning in registration.
Emergency Contacts (Other than Parents) Contact #1 Contact #2 Name______Name______Relationship to Child______Relationship to Child______Home Telephone______Home Telephone______Business Telephone______Business Telephone______Cellular Telephone______Cellular Telephone______
Medical History and Current Information
Current Medical Problems______Drug Allergies______Food Allergies______Insect Allergies______
Current Medications Dosage Schedule ______
Parent/Legal Guardian’s Signature(s) ______
Second Baptist Church Student Ministry 6400 Woodway Dr Houston, TX 77057 Office Phone Number: 713-365-6011 SECOND BAPTIST CHURCH STUDENT MINISTRY Registration and Medical Information Parental Permission and Release
Please indicate if your child has ever had any of the following. If you mark yes to any condition, please explain in detail below including date of diagnosis and current treatment. Yes No Yes No Diabetes/Hypoglycemia ______Depression/Metal Health ______Asthma ______Seizures ______ADD/ADHD ______Migraines ______
Explain:______Any Special Conditions not listed above:______
Medical Release I/We, ______, the parent(s) of ______do hereby give over and release unto the staff and chaperones of Second Baptist Church of Houston all authority and responsibility to authorize any and all medical treatment necessary for the protection of the health and well-being of my aforementioned child. This authorization shall authorize any and all medical treatment by licensed medical personnel, pursuant to the express authorization, whether written or oral of the above mentioned representatives. This authorization shall be effective on February 4, 2011 through February 6, 2011, inclusive or until it is expressly revoked. I hereby grant permission for the Second Baptist Nurse or trained designate to administer over-the-counter medications, including but not limited to: Tylenol, Ibuprofen, Pseudophed, Claritin, Tums, Benadryl, Anti-Itch Cream, Delsym, Visine eye drops. I hereby release Second Baptist Church, its staff, chaperones, and volunteers, from any and all claims and liabilities of whatsoever nature, both individually and collectively, that may arise from my child’s participation in this event. I/We understand that I/we will be financially responsible for any medical costs incurred in the emergency treatment and/or transportation of my child.
Transportation and Property I/We further understand that my child will be transported in equipment owned, leased, or rented by Second Baptist Church. I/We understand that I/we are financially responsible for any damage caused by or in part by my child. This includes all private and public property.
Promotional Release Second Baptist Church has my permission to use any photographs/video of the above named child for brochures, videos, advertising, web page and other promotional items. I/we further understand that these photos/videos will only be used for SBC promotional purposes.
I/We acknowledge that I/we have read and understand all aspects of both sides of this document. I/We agree that copied representations of our signatures should be accepted as binding. Both parent signatures are preferable, but only one parent signature is required.
A copy of your Health Insurance Card must accompany this form for your registration to be complete.
Parent/Legal Guardian’s Signature(s) ______Date:______
Second Baptist Church Student Ministry 6400 Woodway Dr Houston, TX 77057 Office Phone Number: 713-365-6011