LIGHT UP THE NIGHT REGISTRATION

*All teens must be registered w/parent signatures to participate in the physical activities.

The teen(s) listed below has/have my permission to attend the “Light Up the Night” activities @  6007 Justine St ., Van Buren Twp, MI 48111, Jim & Lena Fischer’s house, sponsored by The Merge Community Church on June 29, 2019 from 6-10 PM.

By registering for this event, I agree to not hold The Merge Community Church or its agents liable in the event of an accident or injury of my child. I understand that the teens will be participating in various activities like lighting & handling SPARKLERS and  throwing WATER BALLOONS . (There will be safety protocols presented/supervised by Teen Adult Leaders.) I also understand that there will be a Bible centered message given at the outing at by Bro. Vince Baumgartner, Teen Leader. 

Name 1
Name 1
Name 2 *
Name 2
Name 3
Name 3
Name 4
Name 4
Emergency Phone Contact
Emergency Phone Contact
Parent/Guardian E-Signature
Parent/Guardian E-Signature
Teen #1 E-Signature
Teen #1 E-Signature
Teen #2 E-Signature
Teen #2 E-Signature
Teen #3 E-Signature
Teen #3 E-Signature
Teen #4 E-Signature
Teen #4 E-Signature