Adventure Camp Registration and Waiver & Release

Student Name *
Student Name
Birthdate
Birthdate
Parent Name *
Parent Name
Address *
Address
Phone *
Phone
Parent Cell Phone
Parent Cell Phone
THE CREEK COVENANT CHURCH WAIVER AND RELEASE/ASSUMPTION OF LIABILITY FORM PARENTAL WAIVER AND RELEASE FOR CHILDREN AND/OR YOUTH ACTIVITIES AND AUTHORIZATION FOR MEDICAL TREATMENT Authorization to Participate. This form is to allow my child, named above, to participate in Adventure Camp sponsored by The Creek Covenant Church. I understand this activity or event will involve the following: Riding in vehicles with parental chaperones, visiting museums, hiking, swimming, playing, and participating in various games, activities, and discussions. Certification of Capability to Participate and Understanding of Risks/Assumption of Risks. My signature on this form is my certification that my child is physically capable of engaging in the activities and events described above, and I hereby give my consent for my child to engage in these activities and events. Further, I acknowledge that I have had the risks of my child participating in these activities and events sufficiently explained to me per my request, and I understand the risks posed to my child by engaging in these activities and events (or I have declined such explanation because I already understand the risks involved in the activity or event). In exchange for allowing my child to participate in these church-sponsored activities and events, I hereby assume all risks of injury or damages of whatever type or form associated with my child’s participation in this activity or event.
IF CUSTODY IS SHARED: Parent 2 Name
IF CUSTODY IS SHARED: Parent 2 Name
Parent 2 Address
Parent 2 Address
Parent 2 Cell Phone
Parent 2 Cell Phone