Name *

First Name

Last Name

Phone *

(###)

###

####

Do you have a relationship with Christ? *

Yes

No

Rebirth Liability Waiver *

By checking this box and submitting, I acknowledge that I am voluntarily participating in Rebirth, a baptism conducted by N. 13th and its affiliated organizations and representatives (collectively, the "Organizers”). I understand that participation may involve activities and conditions that carry potential risks, and I accept full responsibility for my own safety. To the fullest extent permitted by law, I release and hold harmless the Organizers, along with their officers, staff, volunteers, and affiliates, from any and all liability, claims, demands, or causes of action arising out of or related to my participation in Rebirth.

Yes, I acknowledge and accept the terms