Signup - Cypress Creek Church

How many Students(Required)

Students Name(Required)

First Last

Students Age(Required)

Allergies

Student 2

Students Name(Required)

First Last

Students Age(Required)

Allergies

Student 3

Students Name(Required)

First Last

Students Age(Required)

Allergies

Parent Release

Emergency Contact(Required)

First Last

Phone Number(Required)

Email(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

I, the undersigned, hereby release Cypress Creek Church, it's agents, employees, officers and servants, from any and all damages and injuries which may occur while (I/ my child) is participating in any/all Cypress Creek Church activities, on or off the premises. I also give my permission for Cypress Creek Church leadership to seek medical attention by a licensed physician in the event of a medical emergency. I certify that I have the legal authority to execute this release on behalf of (myself/ my child). I also agree, by signing below, that the above information is true and correct to the best of my knowledge.

Participant or Parent/Guardian Signature (if under 18 yrs. old)

Date

Insurance

Insurance Company

Policy #

Payment Information

Product Name

Payment(Required)

Pay Online

Pay at the door

Request Scholarship

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