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Midland Evangelical

Free Church

Worship @ 9:00 & 10:45 AM

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Worship Dance Session Registration GRHHA

WORSHIP DANCE SESSION REGISTRATION

The Worship Dance Season runs September through early May for those in 3rd-12th grades. We offer three Sessions throughout the year, and students can participate in one, two, or three Sessions.

Practices/rehearsals occur on Thursdays from 6:30 - 8:00 PM in room 308. Dancers must attend all six rehearsals for each corresponding performance date.
 

SESSION 3 - Performance date: May 19, 2019 


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A separate form must be filled out for each child 

Log into or create a Portal account for a quicker registration experience by clicking "Login" above! Once logged in, your information will automatically populate the below fields.


DANCER INFORMATION

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
*Grade Fall 2018:

SESSIONS
Please select which session(s) you would like to attend:

GENERAL RELEASE HOLD HARMLESS AGREEMENT

Name(s) of parent/guardian if participant is a minor:
Parent/ Guardian Telephone:
*Name of emergency contact:
*Emergency Contact Telephone:


Medical Consent
I hereby authorize Midland Evangelical Free Church (MEFC) and/or activity coordinator to approve medical treatment if necessary.
*Does the participant have any Life Threatening allergies and/or medical conditions?:
If yes, list allergy/condition:
If yes, list reaction:

If the participant is covered by personal/family medical insurance:
Name of insurance provider:
Policy or group number:


Photo/Video Consent
I hereby assign and grant MEFC the right and permission to use and publish/exhibit any photographs/film/video/electronic representations and/or sound recordings made of said participant while participating in the above mentioned activity.


Physical Injury Hold Harmless Agreement
The participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation in the activity listed above.  Except for gross negligence on the part of MEFC, the participant (or parent/guardian) accepts personal financial responsibility for any injury sustained during the activity. 


Safety of Children Hold Harmless Agreement 
MEFC’s Safety of Children Policy as stated in Section II of the Facility Use Agreement (available upon request)  requires two background checked and approved adults to be present in the company of children under 18 years old, and all participants stay in open and clearly visible areas during the activity.  The participant (or parent/guardian) acknowledges and accepts that this policy may not always be adhered to during this activity.


By signing below, the participant (or parent/guardian) accepts full responsibility for any injury sustained and for the care and safety of the participant during the activity listed and as outlined in the Consents and Agreements above. The participant (or parent/guardian) agrees to indemnify and hold harmless MEFC, its staff, members and Board of Elders against any liability or legal action that might result from any injury or loss suffered by the participants if loss or injury is a consequence of participation in the activity.  This includes any expenses, damages, liabilities, losses, actual attorney’s fees and and/or judgments arising out of or in connection with, any claim, demand or action made by any party as a result of the activity or event. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through arbitration.

*Electronic Signature (Participant or Parent/ Guardian if participant is a minor):
*Email (Participant or Parent/ Guardian if participant is a minor):
If you would like to request a copy of this Agreement please contact the MEFC office at 989-631-4411.