TOXIC

Registration - Toxic

* Indicates required field

Student Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Permission and Release Statement
You as the parent and/or guardian are allowing the above student to participate in an event sponsored by Chandler Acres Church and by doing so you as the parent and/or guardian of said student you take full responsibility of your students actions and are liable for any damages, losses, expenses to any property at Chandler Acres Church. You will not hold any of Chandler Acres Church staff or volunteers liable for any damages, losses, expenses as well.

Please read the permission and release statement above *

Yes, My student has permission to attend the Disciple NOW weekend retreatas per the statement above.

Questions or Comments *

Submit