2022 Village Participant Registration

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Name*

First Name

Last Name

Email*

Date of Birth*

Zip Code*

Gender

Male Female Prefer Not to Identify

Cell Phone*

Emergency Contact*

Emergency Contact Phone*

Are you a returning Villager?*

Yes No

What Village were you a part of?

Other, Please Specify

Would you like to remain in the same Village?*

Yes No

I prayerfully commit to being an active and engaged Village member. I’m seeking to grow in Christ and community and I pledge to take every step necessary to make this journey possible. I will make every effort to attend all Village gatherings understanding that my Village experience will be as great as my level of commitment. In consideration for the opportunity to participate in the Alfred Street Baptist Church Events, the Participant acknowledges and accepts the risks of injury associated with participation in the activity. The Participant accepts personal financial responsibility for any injury sustained during the activity. Further, the Participant promises to indemnify, defend, and hold harmless the activity sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the "Sponsor") for any injury related directly or indirectly out of the described activity, whether such injury arises out of the negligence of the Sponsor or otherwise. If a dispute over this agreement or any claim for damages arises, the Participant agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant and the Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel of the American Arbitration Association for final resolution.*

I accept the above and affirm my desire to move from crowd to community.

What days are you available?