Mystery Day - Youth Ministry

MYSTERY DAY 2024

Student Name(Required)

First Last

Student Phone(Required)

Student Email(Required)

Student Rising Grade(Required)

Parent Name(Required)

First Last

Parent Phone(Required)

Parent Email(Required)

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Please note any allergies, medications, or dietary restrictions

Price

Price:

Total

Credit Card(Required)

American Express

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Card Number

Expiration Date

Security Code Cardholder Name

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Consent(Required)

I agree

“I hereby consent to the participation of my child in Mystery Day on Wednesday, July 17th. In consideration of the church making this event available, I do hereby release and discharge Briarwood Presbyterian Church, its employees, and agents from all liability of any kind or nature, claim, demand, or cause of action which might be asserted against the church. In case of illness or injury, Briarwood staff is hereby authorized by me to provide necessary medical care and is released from all legal responsibility. I understand that this is a RELEASE and with that knowledge, I voluntarily agree.”

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