One more thing!

Please fill out the release form below to complete your registration.

Children*

First Name	Last Name	Date of Birth

Parent or Primary Guardian's Information
Name*
Address*
Street Address City State Zip-Code
Home Phone
Cell Phone*
Emergency Contact Person*
Emergency Contact Phone #*
Insurance Co. Name & Policy #*
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*
MM slash DD slash YYYY

Event Information