Oasis 2007 and 2008

SPONSOR Registration Form

IMPORTANT! Please read: Fill out completely and legibly and bring with you to Oasis.
You must have this form completed in order to participate in all scheduled events and activities!

First Name:_______________ Middle In.:______ Last Name:________________________________

Address:______________________________ City:___________________ ST:____ Zip:__________
Phone Number:___________________ Email: ____________________________________________
Male:____ Female:____
Church with whom you’ll be attending Oasis:______________________________________________
Home Church (if different from above):__________________________________________________
In Case of an emergency we should contact:
Name: _______________________________ Relationship: _________________________________
Phone Number/s: __________________________________________________________________
Home Work Cell
Family Doctor Name and Number: _____________________________________________________
Please list any medications you are currently taking:____________________________________
________________________________________________________________________________
Please list any allergies and reactions you have:______________________________________
________________________________________________________________________________
Health Ins. Co: _________________________________ Policy #:____________________________

Medical Release and Liability Waiver

IN CASE OF EMERGENCY: I hereby give permission to Roanoke Bible College, by it’s representatives, Steve Jackson,
Julie Fields or Lisa Pipkin to secure treatment for and to order anesthesia or surgery for me. I further agree to be
responsible for any and all bills incurred for such treatment. I hereby give full authority to the above mentioned
representatives of Roanoke Bible College to use their discretion in determining if such medical treatment is necessary,
and I release Roanoke Bible College from any responsibility of the results of that determination. I also agree to
indemnify and hold harmless Roanoke Bible College and their employees, officers, agents, and/or affiliates in the event
of any damage, either to person or property, I sustain during Oasis.
Name (print):______________________________________________________________
Signature:_______________________________________ Date:____________________________