Rage Room Registration — Connect Church

Your Name

First Name

Last Name

Child

Name of 1st child

First Name

Last Name

Child

Name of 2nd child

First Name

Last Name

Child

Name of 3rd child

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Release of Liability

I will not hold Connect Church or anyone associated with Connect Church responsible for any injury, damages, or loss while attending the Rage Room event being held on February 20, 2021 at Connect Church Life Center in New Brockton, Alabama. I take full responsibility for my children and/or minors that will be accompanying me as well as myself. I also recognize that photos will be taken and may or may not be uploaded to Facebook or other social media platforms. If you agree to these terms please electronically sign your name below.