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2018 Registration Packet
We are excited that you will be joining us for CONNECT this year! Please see the steps below on how to register your group.
If you have any questions, contact Travis ([email protected]) or call 501-376-4791, ext. 5137.
1. Complete and mail in the Group Registration Form (Form 1) along with your payment. Due on or before Wednesday, March 28th.
2. Mail in the Group Names Form (Form 2) (You can type your responses directly into this form.) Due by Wednesday, April 4th.
3. Hand out Student and Adult Registration and Release forms to your participants.
4. Collect Student and Adult Registration and Release forms and bring them with you to CONNECT on April 13th.
GROUP REGISTRATION FORM (FORM 1)Due on or before Wednesday, March 28, 2018
Registration is non-refundable however is transferable to another participant.
State: Zip Code:
Please Print Church Name:
Contact Person:
Address:
City:
Phone: Email:
Registration: # of Students _________
# of Adults _________
Total _________ X $25.00 = $ __________ amount Enclosed
Vehicle/Capacity (15 person van/25 person bus/etc.) ______________________________________________
Who will be the driver(s) for your group? ________________________________________________________
Will you be staying for Sunday worship? __________________________
Please complete this form and mail with your payment to: Missions Team | 10 Remington Dr. | Little Rock, AR 72204
For more information, contact: Travis at ([email protected]) || 501-376-4791, ext. 5137
A ministry of the Cooperative Program and the Dixie Jackson Arkansas Missions Offering.
Student Registration and Release Please have each parent fill out, sign, and return this form for their student.
Name: _________________________________________________________________
Church: ________________________________________City:_____________________
Age:__________ Grade:___________ Date of Birth: ____________________
Address: ________________________________City, State, Zip: ____________________
Student Agreement:
I hereby consent to participation by ____________________________ my son/daughter/individual under my guardianship, in CONNECT 2018. I understand that my child will be under the supervision ofthe designated staff and/or volunteers at this event. I understand that such an undertaking involves an element of risk. I assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify, and agree to hold harmless ________________________________ (henceforth referred to as “the Church”), its staff, deacons, chaperones, volunteers, membership, and drivers from any and all liability that may arise out of participation in this activity. I also give consent for emergency medical treatment if necessary, as determined by the chaperones of the Church. I also agree to hold harmless and release the Arkansas Baptist State Convention (henceforth referred to as “the Convention”), other participating churches, and the Church, to include their staff, deacons, chaperones, volunteers, membership, and drivers from any and all liability related to expenses arising from the giving of such medical care to the extent those expenses are not reimbursed by me or my child’s health insurance provider(s). As parent/legal guardian, I remain fully liable for any legal responsibility which may result from any personal actions taken by the named participant.
I hereby grant permission to the Church and Convention to use my child’s/individual’s under my guardianship likeness on its promotional materials including, but not limited to videos, web sites, and printed materials without further consideration, and I acknowledge the Convention and Church's right to crop or treat the likeness at its discretion.
Parent/Guardian Signature: ________________________________ Date:____________
Insurance Company:_______________________________ Policy #:_________________
Physician: ____________________________________ Phone #:____________________
Date of Last Tetanus Shot: _____________________________
In Case of Emergency Notify: ________________________________
Phone #:_________________________________
In Case of Emergency Notify: _________________________________
Phone #:_________________________________
Church’s
Name
Student’s name
Adult Registration and Release Please have each adult fill out, sign, and return this form.
Name: _________________________________________________________________
Church: ________________________________________City:_____________________
Age:__________ Date of Birth: ____________________
Address: ________________________________City, State, Zip: ____________________
Chaperone Agreement:
I, ________________________________, assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify, and agree to hold harmless __________________________ (henceforth referred to as “the Church”), its staff, deacons, chaperones, volunteers, membership, and drivers from any and all liability that may arise out of participation in this activity. I also give consent for emergency medical treatment if necessary, as determined by the chaperones of the Church. I also agree to hold harmless and release the Arkansas Baptist State Convention (henceforth referred to as “the Convention”), other participating churches, and the Church, to include their staff, deacons, chaperones, volunteers, membership, and drivers from any and all liability related to expenses arising from the giving of such medical care to the extent those expenses are not reimbursed by my health insurance provider(s). I remain fully liable for any legal responsibility which may result from any personal actions taken by the named participant.
I hereby grant permission to the Church and Convention to use my likeness on its promotional materials including, but not limited to videos, web sites, and printed materials without further consideration, and I acknowledge the Convention and Church's right to crop or treat the likeness at its discretion.
Signed: _____________________________________________ Date: _______________
Insurance Company:_______________________________ Policy #:_________________
Physician: ____________________________________ Phone #:____________________
Date of Last Tetanus Shot: _____________________________
In Case of Emergency Notify: ________________________________
Phone #:_________________________________
In Case of Emergency Notify: _________________________________
Phone #:_________________________________
Chaperone’s name Church’s
Name
Group Names Form (Form 2)Due on or before Wednesday, April 4th, 2018.
E-mail to Travis: [email protected]
Fax to Missions Team: 501-376-7463
Church Name/City: ___________________________________________________
Group Leader: _______________________________________________________
E-mail Address: ______________________ Phone Number: __________________
Name Adult/Student Male/Female 1st Choice* 2nd Choice*
* If your participants prefer a certain type of work project, please indicate in the last two columns. *Project choices: Light Construction, Painting, Block Party, Evangelism, Sports Ministry, Prayerwalking,
Cleaning/Yardwork, Surveying Neighborhoods, Backyard Bible Club, Senior Adult Ministry
Schedule Friday – 6:30 – Registration 7:30 – Connect with groups and Leader’s Meeting 8:00 – Making the Connection (Worship) 9:30 – Connect with your Team 10:00 – Free Time and Concessions
Saturday 6:00 – Wake Up/Devotion 7:00 – Breakfast 7:30 – Evangelism Training and Prayer Time 8:00 – Connect with Community (leave for worksites) 6:00 – Dinner 7:15 – Connect with your Ministry Team (debriefing) 7:45 – Making the Connection (Worship) 9:00 – Church Debriefing
Free Time
Sunday 7:30 – Breakfast
Clean up Connect with Local Church (beginning times will vary) Lunch with Local Church Connect with your Community (head home)
What to Bring Work clothes for Saturday
Tennis shoes (no open-toed shoes at worksites)
Change of clothes for Saturday night/Sunday morning
Sleeping bag or sheets/blanket
Air Mattresses/pump (All lodging is in a local church which will include sleeping on the floor.)
Pillow
Toiletries (shampoo, soap, deodorant, toothbrush, toothpaste etc.)
Towel/washcloth
Bible
Pen/paper
Money for snacks (CONNECT T-shirts will also be available for $10/$15)
Earplugs (if you’re worried that you might not get any sleep because of all of the snoring)
Your group will also receive a list of supplies to bring specific to the jobs that your
participants will doing. You will receive this list by the week of the event.
What NOT to bring: Bad attitudes
No weapons of any kind (guns, knives etc.)
No silly string, shaving cream, or anything used to play practical jokes
No fireworks
No drugs, cigarettes, alcohol etc.
No shirts with inappropriate messages, pictures etc.
Leave expensive jewelry and other items at home (these are unnecessary and might get
lost/broken and/or stolen).
IPods, MP3 players etc.
We are not responsible for any lost/damaged or stolen items. Cell phone usage is discouraged
during worship, ministry, and any group activities except in the case of an emergency.
