March 25, 2023 County Line Country Music Band- GCCC Fundraiser

Primary Participant's Name

Additional Participants Names (please list everyone else attending or put none)

If anyone participating (mentioned above) is under the age of 13, please list their names

Address

Primary Participant's Home Phone Number

Primary Participant's Mobile Phone Number

Primary Participant's Email Address

This address will receive a confirmation email

Consent for Medical Treatment, Indemnity and Assumption of Risk

I/we authorize the leader in charge to arrange for myself/us to receive such first aid, medical or surgical treatment, as the leader may deem necessary or appropriate at any time. I/we further authorize the use of ambulance or anesthetic by a qualified medical practitioner if, in the leader's judgment, it is necessary or appropriate. I/we accept responsibility for payment of all costs and expenses associated with such treatment.

I/we agree to indemnify and hold harmless the Garden City Community Church and the leaders, drivers and chaperones against any and all claims, demands, suits, costs, expenses and liabilities of whatever nature and howsoever arising out of any injury to myself/us, and the program, activity, or event described above and any activities incidental thereto.

I/we acknowledge that the Garden City Community Church is not liable for any injury that may occur when driving to or from church events, and this includes carpool arrangements in which drivers invite passengers into their cars for purposes of rideshares. Furthermore, I/we agree to assume the risk of any injury when participating in the event.

I/we grant consent to my/our child to paticipate in the Garden City Community Church County Line Country Music Band Fundraiser, and to participate in any programs or activities associated with this event.

I/we will encourage my/our child to co-operate with the leaders and other participants. In the event that the leader in charge determines that my/our child's behavior is unduly disruptive or threatens the safety of my/our child or anyone else, I/we agree to promptly take responsibility for my/our child at the place of the program, activity or event.

I/we consent for medical treatment, indemnity and assumption of risk for everyone registered for the event I/we do not consent for medical treatment, indemnity and assumption of risk for anyone registered for the event

Consent for Photography Use:

I/we give the Garden CIty Community Church permission to publish my or my child's photograph(s) in local papers, on the Church's website page, or on the Church's social media pages.

I/we understand that these photos may only be used in church publications or on a website designed to publish information about Garden City Community Church. Children's names will not be used in any of these publications.

By agreeing below, I/we acknowledge my/our understanding of the above and grant my permission for use of the photograph(s).

Use of Photos

I/we consent to allow my or my child's photo(s) to be used I/we do not consent to my or my child's photo(s) being used

Entrance Fee

The fee for attendance is $20 per person age 13 and over. Children age 12 and under are free. Here is a guideline for the entrance fees for anyone age 13 and over
1 person $20.00
2 people $40.00
3 people $60.00
4 people $80.00
5 people $100.00
6 people $120.00

Fees for anyone age 13 and over ( see above fee schedule)

Free Will Donations

Free will donations will be gladly be accepted and will go towards supporting the mission of our church.

Free will donations

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

March 25, 2023 County Line Country Music Band- GCCC Fundraiser

Description

Please Fix the Following