Informed Consent and Acknowledgement
EPWORTH UNITED METHODIST CHURCH
1030 BURRAGE RD NE . CONCORD, NC 28025
704.786.6183 . DUHSCIPLES@GMAIL.COM
I understand the objective and goals of the Backyard Mission Camp. I agree to participate in community service projects and camp activities to the best of my ability. I agree and hereby state that I am aware and understand that all of the camp activities are strictly voluntary and it is my own choice to participate in each activity to whatever degree I deem appropriate and after due consideration of my own physical health, physical abilities and medical conditions. I have informed Epworth’s Director of Youth Ministry and/or the Backyard Mission Camp adult volunteers of any medical conditions I may have. I further state that in choosing to participate I am not under the influence of any illegal chemical substances including alcohol.
I willingly and knowingly assume for myself, my heirs, family members, executors, administrations and assigns all risk of physical injury and sickness and emotional upset which may occur during or after participating in any aspect of the projects or camp activities and hereby agree to hold Backyard Mission Camp at Epworth United Methodist Church, Inc., its employees, members, or trustees harmless for any liability arising out of my participation in the event. Also, I hereby give permission for photographs taken of my child/me during this event to be used in camp and/or church publicity, reports and recruitment.
I have read, or have had read to me, all information regarding the Backyard Mission Camp my child is attending at Epworth United Methodist Church, Inc. including policies, procedures, limitations, and possibilities, and have discussed these with my child as named above. My child, as named above, has permission to participate fully in all camp activities.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.