Personal Baptism Class Registration

PERSONAL BAPTISM CLASS REGISTRATION

Registration Details

Registration Date:   Class Session Date(s):

Participant Information

Date of Birth:   Gender:

Primary Phone:   Email:

Emergency Contact

Relationship:   Phone:

Parent / Guardian (if participant is under 18)

Relationship to Participant:   Phone:

Religious Background

Denomination / Church Affiliation:

Previously Baptized? Yes    No

Class Selection & Fees

Selected Class Location:   Preferred Time:

Payment Method: Check Cash Other (describe below)

Medical Information & Consent

Health Insurance Provider:   Policy Number:

Emergency Medical Authorization:

By checking the box below I authorize designated class leaders and authorized staff to seek emergency medical care for the participant if I cannot be reached. I understand I will be notified as soon as practicable and that reasonable attempts will be made to contact the emergency contact listed above.

I authorize emergency medical treatment as described above.

Waiver, Release, and Photo Consent

Liability Waiver: The participant or parent/guardian acknowledges that participation in classes involves normal risks associated with group activities. To the fullest extent permitted by law, I release and hold harmless the sponsoring church, its employees, volunteers and leaders from liability for personal injury, death, or property loss arising out of participation in baptism class activities, except for acts of gross negligence or intentional misconduct.

Indemnification: I agree to indemnify and defend the sponsoring organization against any claims, liabilities, or costs arising from my negligent acts or omissions in connection with class participation.

Photo/Media Release: I grant permission for non‑exclusive use of photos, video, or audio recordings of the participant for educational or promotional materials produced by the sponsoring organization.    I do not grant permission.

Attendance, Cancellation & Privacy

Attendance and Cancellation: Registrant agrees to attend scheduled sessions. Cancellation requests must be submitted in writing. Fees may be non‑refundable after classes begin; exceptions considered at the discretion of class administrators.

Records and Privacy: The information provided will be used for class administration and emergency purposes. Contact information will be maintained by the sponsoring organization in accordance with its privacy practices and will not be sold or distributed for commercial purposes.

Acknowledgment and Consent

I certify that the information provided on this registration is true and complete to the best of my knowledge. I have read and understand the Liability Waiver, Indemnification clause, and Photo/Media Release above. By signing below I agree to comply with the policies and to the consents indicated.

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