Church Camp Form

Church Camp Form

Form is used by campers to register for a Church sponsored event. Form Preview
SUMMIT LAKE 2017
  • Icon Church Camp-- July 3-7 2017

  • Camper Name

  • Camper's Information

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  • Parent or Legal Guardian Information

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  • Email Confirmation

  • Health Information

    A health officer is on site at all times.
  • It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. If the information has changed on the day of registration please see the health officer at that time.  Please bring all medication in ORGIANAL CONTAINER or you will not be allowed to leave the medication or vitamins at the camp.  No exceptions.  All prescriptions must be in that campers name and the correct dosage.  

  •  -  - Pick a Date
  • All fileds are required below.  If nothing applies, please put "NONE" in the box.  Thanks.

  • Basic Medications: 

    Throughout the course of the week, it is possible for a student to develop minor illness or ailments, such as headache, stomach ache, heartburn, sinus problems, sunburn pain, or soreness. In the event that this may occur I, the undersigned, hereby grant permission to a Summit Lake staff/volunteer to administer any of the following basic medications: (check all that apply) If your student has never taken one or more of these medications please do not check them below.

  • Payment Information

    $50 Registration Fee Due. This Payment can be sent to the church office in the form of a check. You may also use the pay online option on our website. Your registration will not be finalized until the registration fee has been received.
  • Camper Release

    • Be certain to enter your email address  correctly on the registration form to receive confirmation via email with in 2 weeks
  • TERMS AND CONDITIONS: The undersigned or a member of the immediate family of the undersigned desires to participate in various programs, events, or activities (hereinafter collectively referred to as “Activities”) operated or sponsored by the Connections Community Church (hereinafter referred to as “Church”), and Icon Student Ministry (hereinafter referred to as “Student Ministry”) taking place at Summit Lake Camp (hereinafter referred to as “Camp”)

    The undersigned or a member of the immediate family of the undersigned further understands and acknowledges that the undersigned or a member of the immediate family of the undersigned may incur personal injury or bodily damage while participating in such Activities.

    The undersigned or a member of the immediate family of the undersigned further understands and acknowledges that the Church, Student Ministry, and the Camp would not allow the undersigned or member of the immediate family of the undersigned to participate in such Activities without releasing and holding harmless the Church, Student Ministry, and Camp.

    Further, the undersigned or a member of the immediate family of the undersigned request that the Church, Student Ministry, an Camp in consideration thereof agree to hereby release, and forever discharge the Church, Student Ministry, Camp and their offices and directors, and their employees, and their agents, and any parties volunteering of behalf of the Church, Student Ministry, and the Camp from all actions, claims, costs, expenses or damages of any kind growing out of or related to any Activity of the Church, Student Ministry, and Camp in which the undersigned or a member of the immediate family of the undersigned participates.

    The undersigned or a member of the immediate family of the undersigned further acknowledge that this is a full and complete release form for all injuries and damages which the undersigned or a member of the immediate family of the undersigned may sustain as a result of the undersigned or a member of the immediate family or the undersigned participation in any Church program.

    By signing below you are giving legal permission for him/her to go to the Summit Lake Camp 2017 under the direction of Icon Stundent Ministries and Connections Community Church. The undersigned, being a parent and/or guardian of the above minor(s), does hereby authorize the treatment of the above minor(s) by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her/their life, cause disfigurement, physical impairment, or undue discomfort if delayed, while said minor is participating in the above event, including transportation to and from the event site. The authority is granted only after a reasonable attempt has been made to contact me.

    VIDEO/PHOTO RELEASE:I, hereby grant permission to Icon Student Ministry/Connections Community Church or any organization associated with Icon or CCC to photograph the undersigned and to record their voice, performances, poses, acts, plays and appearances, and use their picture, photograph, silhouette and other reproductions of my physical likeness and sound as part of Icon Youth tentatively entitled “Promo Video” and the unlimited distribution, advertising, promotion, exhibition and exploitation of the picture by any method or device now known or hereafter devised in which the same may be used, and/or incorporated and/or exhibited and/or exploited.

    I agree that I will not assert or maintain against you, your successors, assigns and licensees, any claim, action, suit or demand of any kind or nature whatsoever, including but not limited to, those grounded upon invasion of privacy, rights of publicity or other civil rights, or for any other reason in connection with your authorized use of my physical likeness and sound in the picture as herein provided. I hereby release you, your successors, assigns and licensees, and each of them, from and against any and all claims, liabilities, demands, actions, causes of action(s), costs and expenses whatsoever, at law or in equity, known and unknown, anticipated or unanticipated, which I ever had, now have, or may, shall or hereafter have by reason, matter, cause or thing arising out of your use as herein provided.
    I affirm that neither I, nor anyone acting for me, gave or agreed to give anything of value to any of your employees or any representative of any television station, network or production entity for arranging my appearance on the picture.

    TRANSPORTATION PERMISSION: The undersigned does also hereby give permission for
    my child/youth to ride in any vehicle driven by an approved and licensed ADULT chaperone
    while attending and participating in activities sponsored by Connections Community Church. My child/youth and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during
    transportation.

    I have read the foregoing pages and fully understand the meaning and effect thereof. I submit that I have the legal authority to make these decisions for the participants listed, have read both pages of this release and, intending to be legally bound, I have signed this release.

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