Christ Community Church - Men’s Weekend 2016 Registration

Men’s Weekend 2016 Registration - August 12-14

Full Name	*
Nickname (For Name Tag - Not Required)
Street Address	*
City	*
State	*
Zip Code	*
Phone Number	*
Your Email Address	*
Emergency Contact Name	*
Emergency Contact Relationship	*
Emergency Contact Phone Number	*
Alternate Emergency Contact Phone (If Applicable)
Choose a Saturday Activity You’re Interested In: First Choice	*
Choose a Saturday Activity You’re Interested In: Second Choice	*
I am fully aware of the risks and hazards connected with the activities of the C3 Men’s Weekend and the outdoor activities I have elected to do, and I am aware that such activities include the risk of injury and even death, and I hereby elect to voluntarily participate in said activities, knowing that the activities may be hazardous to my property and me. I understand that C3 does not require me to participate in this activity. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent allowed by law	*
The camp cost is $195
Scholarship assistance is available
Please contact the C3 office for details 304-905-9000
NO REGRETS!
PAYMENT AMOUNT	* $

Total	$