July 24-27th, 2023 5:30PM to 8:30PM
Meadowbrook Church Mega Sports Camp
12 Lupo Drive, Beaufort, SC
Child's Name
LAST Name
FIRST Name
Parent/Guardians Name
Last Name
First Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell or Home Number
-
Area Code
Phone Number
Work Number
-
Area Code
Phone Number
E-mail
example@example.com
Child's Birth Date
-
Month
-
Day
Year
Date Picker Icon
Gender
Female
Male
Last Grade Completed
Please list any medical information we may need to know including allergies.
Emergency Contact Number
-
Area Code
Phone Number
Emergency Contact Name
First Name
Last Name
Who is allowed to pick up your child after dismissal each day? Please list all.
Does your child attend Church on Sundays? If so, where?
If your child is visiting our church, who are they a guest of?
The first 100 get a free T-SHIRT! What is your size
Youth Small
Youth Medium
Youth Large
Youth Extra Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
What is your FIRST choice Sport/Activity (ages 3-5 Must Choose ALLSTARS for both)
ALLSTARS (ages 3-5 must choose ALLSTARS)
ART
Basketball
Cheer
Football
Soccer
Total Body Fitness
What is your SECOND choice Sport/Activity (ages 3-5 Must choose ALLSTARS for both)
ALLSTARS (ages 3-5 must choose ALLSTARS)
ART
Basketball
Cheer
Football
Soccer
Total Body Fitness
Informed Consent and Acknowledgment
I hereby give my approval for my child’s participation in any and all activities prepared by Meadowbrook Church during the selected camp. In exchange for the acceptance of said child’s candidacy by Meadowbrook Church, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Meadowbrook Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.In case of injury to said child, I hereby waive all claims against Meadowbrook Church including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities.I grant Meadowbrook Church my permission to photograph my child during activities at Mega Sports Camp. These photographs will remain the property of Meadowbrook and may be used in advertising or marketing campaigns on websites, and for promotional and informational material. I understand my child will not be identified by name. I hereby waive and release on behalf of my child, any rights to compensation for, or ownership of such images.
Medical Release and Authorization
As Parent and/or Guardian of the named athlete, I hereby authorize the first aid treatment by an agent of Meadowbrook Church, of the minor child, in the event of a medical emergency, which in the opinion of the attending agent, requires immediate attention.I understand that every attempt will be made by the attending agent to contact me in the most expeditious way possible. Release authorized on the dates and/or duration of the registered season.This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation
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.
SIGNATURE
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