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3031 Long Hollow Pike

Hendersonville, TN 37075

615.824.4006

Non-Proft Org.

US Postage

PAID

Permit No. 17

Goodlettsville,

TN 37072

Name_______________________________________________________ Birthdate_______________________ Grade______________

Address ______________________________________________________________________ School___________________________

City/State/ZIP________________________________________________________ Home Phone________________________________Students cell phone _______________________________ Students Social Security #________________________________________

Students e-mail _________________________________________________________________________________________________

Parents Names______________________________________________ Parents Work Phone__________________________________

Mother s cell _________________________________________ Fathers cell _______________________________________________

MEDICAL INFORMATION

Family Physician______________________________________________________________ Phone_____________________________

Address___________________________________________________________ Emergency Phone_____________________________

Insurance Company___________________________________________________ Policy #____________________________________

Members Name______________________________________ Ins. Company Phone #_______________________________________

Allergies_______________________________________________________________________________________________________

Medication being taken___________________________________________________________________________________________

Physical Handicaps or Special Conditions____________________________________________________________________________

MEDICAL AND SURGICAL WAIVER

Also: Property Damage, Transportation for Disciplinary Reasons and Personal Property Searches

I am the parent and/or legal guardian of _________________________________ and hereby acknowledge that he/she is under my care, custody, and control.In the event there arises an emergency necessitating medical/surgical attention, I expressly grant my permission and consent to the Long Hollow Baptist

Church staff, its representatives, sponsors, or any attending physician, to make such decisions and to perform such medical treatments and/or surgery upon my

child listed above which may in their sole discretion be necessary and proper under the circumstance. I, the undersigned parent and legal guardian of above

mentioned child, do release, acquit, discharge, and covenant to indemnify and hold harmless Long Hollow Baptist Church or its representatives, the sponsors,

or any attending physician, from any and all actions, causes of actions, related risks and dangers, including negligence, damages, liabilities arising out of the

treatment of any sickness or accident, and any nancial responsibility for all medical treatment provided.

I also assume nancial responsibility for any damage my child may cause, and for providing transportation home should it become necessary for disciplinary

reasons.

I also give my permission to the Long Hollow Baptist Church staff, its representatives, and the adult sponsors and chaperones to search my childs personal

belongings, including but not limited to all luggage, purses, and backpacks, if deemed necessary on rare occasion for security reasons.

________________________________________________ _____________________

Signature of Parent or Guardian Date

Long Hollow Baptist Church Medical Release Form

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the themeA Jewish theologian once said, He who is not willing to be anheir, does not deserve to be a pioneer. In other words, onemust become Timothy beore one can ever be Paul. This year weollow the calling o the most dynamic and inuential individual,with the exception o Jesus, in all o history: the Apostle Paul.From his ultimate calling o salvation to the dening moment osurrender to capturing the moments o lie as a living sacriceand nally embodying the concept o service with his dyingbreath... Paul answered the call. With undeniable clarity, thecalling still exists today to be separated to the gospel o God,surrender my lie as a blank check to Him, live every moment asi it were my last and serve until my dying breath.

who can attend?6th - 12th grade students and all their riends

where?Long Hollow Baptist Church and local host homes.

how much?$50*cost includes program ee, lunch and dinner on Saturday, t-shirtand curriculum. Make sure to register your riends early too!

how to register:1. Fill out the registration and medical release orm on thebottom. Turn it in to the welcome desk at Small Groups or inthe Drop Box in the Dome.

2. Turn your money in to the Drop Box in the Dome, the oferingslot by the Worship Center, or in the ofering basket. Makesure to put each students name in the memo line.

* You can also log on to www.longhollow.com to register andpay or Quest!

notes:A ew weeks beore Quest, pick up a Preview Pack with all thedetails you will need to know or the weekend. This will alsobe available online at www.longhollow.com.

Students Name: ______________________________________ School: __________________________ Grade: _________

Address: ________________________________________________ City: ______________ State: ______ Zip: _________

Phone: _____________________________ Cell Phone: ____________________________ Campus: Hendersonville

T-shirt size: YM YL YXL S M L XL XXL XXXL Gallatin

White HouseList 3 riends you would like to have in your small group:

_________________________________________________

_________________________________________________

_________________________________________________

I you were invited by a Long Hollow Student, please listtheir name here: ___________________________________

Parent Ino:

For more inormation about Quest 2010, pick up a Preview

Pack at any o the Welcome Desks. The Preview Pack will

also be availble on www.longhollow.com.

Signed: __________________________________________________ (Parent or Guardian) Date: _____________________

Medical Release orm on back