Registracion General Encuentristas

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ENCOUNTER REGISTRATION

Congratulations! We are happy about your decision to participate in an "Encounter with God" We are sure your life will be transformed and blessed. To serve you with excellent, completely fill out the form below. Fill once per participant. Investment is $50

Please note that this electronic form includes signatures and initials that only the participant can provide. IF YOU ARE FILLING OUT THIS FORM ON BEHALF O SOMEONE ELSE, IT IS NECESSARY THAT THE PARTICIPANT IS WITH YOU AS YOU FILL OUT THIS FORM SO HE/SHE CAN SIGN AND PLACE INITIALS

If a minor is the participant, only one of his parents or legal guardian can fill out this form

Click next to continue.

Is the participant a minor (younger than 18 y/o?)*

NoYes

Name of the person who is filling out this registration*

First NameLast Name
Phone Number*
Relationship to the minor*

FatherMotherLegal guardian

Name of the participant*

First NameLast Name
Gender*

MaleFemale
Address*

#, Street

Street Address Line 2

CityState

Zip Code
DOB*

MonthDayYear
Age*
E-mail*

Confirmation Email
Cellular*
Estado Civil / Civil Status*

MarriedSingleDivorcedMarried but separatedIn a free unionWidow (er)
Your network*
Name of a group Leader*

First NameLast Name
Encounter Leader*

First NameLast Name
Emergency Contact 1*

Nombre NameApellido Last Name
Emergencia 1*
Emergency Contact 2

Nombre NameApellido Last Name
Emergencia 2

The following section has 3 documents and authorizations that you need to read carefully and sign.

READ BEFORE YOU CONTINUE: If you are filling out this form on behalf of another ADULT, is obligatory that this person is with you in order for him/her to sign this form.

This form and all its sections comply with all security procedures and statutes specified in the State of Florida statute number 668.50 and any other State statute or federal law regarding digital signatures (esignatures)

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(DOCUMENT 1 of 3)

WAIVER OF LIABILITY AND CONSENT TO PARTAKE IN ACTIVITY

The undersigned has agreed to partake in an activity, and or trip which is referred to as follows. If participant is a minor, then their parent or legal guardian has agreed and signed below. The activity is: ENCOUNTER WITH GOD

And in so agreeing does hereby states the following:

1. In the event of an emergency, I would request that you contact the person named as EMERGENCY CONTACTS specified in this form if for myself, but if on behalf of my minor child, please contact me at contact infromation provided by myself.

2. I hereby agreed to hold COMUNIDAD CRISTIANA P.P., its agents, employees, and/or volunteers harmless from any and all injuries, accidents, costs, losses, causes of action, claims, damages and/or liability that may result from the participation in the above Activity, the transportation to and from the Activity, and in general everything having to do with the Activity. I understand that the participation in the above activity is strictly voluntary and I am willing to assume all of the potential risks involved in the Activity on my behalf or on behalf of my minor child

3. I agree that COMUNIDAD CRISTIANA P.P. is not responsible for the medical care or insurance coverage for any injury, accident or medical emergency which may occur as a result of the participation or transportation to and from said Activity, by me or my minor child.

4. I am aware and agree that no insurance or medical care coverage has been obtained by COMUNIDAD CRISTIANA P.P. for me or on my behalf, or on behalf of my minor child.

5. I agree that I have medical coverage or insurance, for me or my minor child, in the event of an emergency, and if I do not have medical coverage or insurance for me or my minor child, then I shall take full responsibility for any and all costs of medical care or treatment, in the unlikely event of a medical emergency.

6. I recognize that in the event do, or cause to be done, or participate in any activity that is unbecoming of the nature of the activity, in other words, if I do anything that negatively reflects upon COMUNIDAD CRISTIANA P.P.. COMUNIDAD CRISTIANA P.P. reserves all rights to bring a legal action against me for any harm I may have caused to its name and/or image.

7. I have read and I agree to all of the above, and I choose to partake in the above activity (if over the age of 18), or give permission for the minor whose name is detailed in this form to participate in the Encounter with God.

I HEREBY SIGN THIS WAIVER OF LIABILITY AND CONSENT TO PARTAKE IN THE ABOVE ACTIVITY, ON BEHALF OF MYSELF OR ON BEHALF OF MY MINOR CHILD, AND IN SO DOING FULLY UNDERSTAND THAT I WILL NOT HOLD COMUNIDAD CRISTIANA P.P. ITS EMPLOYEES, AGENTS, AND/OR VOLUNTEERS, RESPONSIBLE FOR ANY INJURIES, ACCIDENTS, COSTS, LOSSES, CAUSES OF ACTION, CLAIMS, DAMAGES AND/OR LIABILITY THAT MAY RESULT FROM THE PARTICIPATION IN THE ABOVE ACTIVITY AND/OR THE TRANSPORTATION TO AND FROM THE ACTIVITY.

(DOCUMENT 2 of 3)

ABSTINENCE AGREEMENT

We are sure the Lord will work in your mind, heart, and soul and that you will find on this Encounter all that you need and seek. In his sovereignty, God allows sometimes that the restoration process takes time.

Therefore, it is important that you commit on this note that you will not bring to the Encounter any form of drugs, alcohol or cigarettes.

If you do not comply with this commitment, or if you consume any of the items above, you will be sent back immediately to your home without finishing the Encounter and your investment will not be reimbursed.

God bless you!

(DOCUMENT 3 of 3)

PERMISSION TO USE PHOTOGRAFIES AND/OR VIDEO

I grant (CCPP), its representatives or employees the right to take photographs or video of me and/or my properties in relation to the "Encounter with God". I authorized CCPP to copy, transfer, use, publish either printed or electronically all of these photographs or video.

I agree with CCPP for the use of photographs or video, with or without a name, for any legal use including but not limited to advertisement, publicity, illustrations, web or social media.

Your signature (if participant is minor, the signature of one of his/her parents or legal guardian)*
Your initials*
Investment
prevnext( X )
Encounter$50.00
No reimbursements nor can be transferred to another encounter
Once you clikc, you will be taken to the payment platform. The person who pays can be different from the participant
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