By Check­ing & Tying your name below you agree: As a par­tic­i­pant I agree to abide by all the rules set forth by the DBA SURGE com­mit­tee. I fur­ther under­stand that fail­ure on my part to com­ply with rules and direc­tions giv­en by the event orga­niz­ers and youth lead­ers that are serv­ing as coun­selors and chap­er­ones of the event will mer­it my imme­di­ate dis­missal at my parent/guardian’s expense.

By Check­ing and Typ­ing your name below you agree: As a parent/guardian I agree to allow my child to attend Win­ter Surge. I under­stand that the event orga­niz­ers, the DBA, indi­vid­ual DBA church­es or FBC Mt. Ver­non, will not be held liable for injuries incurred as a result of my child’s atten­dance at this event. Should injury or ill­ness, oth­er than minor, arise, I give my per­mis­sion for med­ical care to be pro­vid­ed. I shall be ful­ly respon­si­ble for pay­ment of such cost. I also give my per­mis­sion for any pho­tographs tak­en of my child to be used for pos­si­ble pro­mo­tion pur­pos­es. I also give my per­mis­sion for my child to be trans­port­ed from FBC Mt. Ver­non to par­tic­i­pate in a local mis­sion project.

If you have any ques­tions, please call Jes­si­ca Jones at (912)-293‑6258