Teen SOYO Pumpkin Farm Outing Registration – Saint George Antiochian Orthodox Church

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Event Name

Event Date

Membership Information

Are you a registered member of Saint George Church?*

Yes

To attend this trip, you or your family must be members of Saint George. Please complete the Online Membership Form.

Teen Information

Name*

First Last

Birth Date*

Allergies/Food Allergies/Conditions/Medications:

Teen Email*

Teen Cell #

Parents Information

Mother's Name*

First Last

Mother's Cell #*

Mother's Email*

Father's Name*

First Last

Father's Cell #*

Father's Email*

Consent and Payment Processing

Attendee Fee

I give consent for my participation and/or my (above) child’s participation in the Teen SOYO event indicate above.

I hereby absolve Saint George Antiochian Orthodox Church of Cicero, IL, the Antiochian Archdiocese, affiliate organizations, employees and representatives, of any liability in the event of accident or injury during my participation and/or my child’s participation in this trip. In addition, I understand I must notify the Teen SOYO advisors and Church staff of any medical history which may cause any harm during my participation and/or my child’s participation in the program.

I, also, grant permission for the appropriate use of any photographs, audio recordings, video images, or any other visual or audio reproduction that may be taken of myself and/or my child during this trip to be used in a video, website, social media, for promotional purposes of the program, or shown as Saint George Church sees fit.

Furthermore, I understand only proper conduct and behavior befitting the Church will be allowed and disrespectful behavior may result in the dismissal of any person causing misconduct at the cost and responsibility of the said person.

Total Due:

Please proceed to credit card section to pay this balance.

Billing Address*

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Credit Card*