XA 2022 Registration

2022 Xtreme Adventure Registration
Xtreme Adventure is for incoming 5th, 6th & 7th graders (school year 2022-2023). Camp is July 11-14 from 9am-12pm at Hill Country Bible Church, Lakeline Location. (12124 RR 620 North, Austin, TX 78750)
Cost

The cost for XA is $50 (non-refundable) & $60 at the door, while spots are available.
Cancellations/Refunds

If you need to cancel your student's registration at a later time, please email childrens@hcbc.com. The $50 fee is non-refundable.
Student Information
Student's Name *

First Name Last Name
Student's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Grade entering in 2022-2023 school year: *

5 7 6
School you'll be attending NEXT year (2022-2023 school year): *
Gender *

Male Female
Shirt Size (Adult Sizes) *

Small Medium Large X-Large XX-Large
Which Hill Country location do you most often attend? *

Lakeline Steiner Ranch Online I attend another church I don't regularly attend
Which church do you attend?
Whom may we thank for inviting you to XA? *
Who will you invite to join you at XA? *
Parent Information
Parent Name *

First Name Last Name
Additional Parent Name (Optional)

First Name Last Name
Parent Cell Phone *
Please enter a valid phone number.
Additional Parent Cell Phone (Optional)
Please enter a valid phone number.
Parent Email *
example@example.com
Additional Parent Email (Optional)
example@example.com
Alternate Emergency Contact *

First Name Last Name
Alternate Emergency Contact Phone *
Please enter a valid phone number.
Physician Name *

First Name Last Name
Physician Phone *
Please enter a valid phone number.
Allergies or anything else you would like us to know?
Waiver/Release
Liability Release – XA 2022, July 11-14, 2022This voluntary extracurricular activity is being offered through, or held on the premises of, Hill Country Bible Church Austin (HCBC). HCBC urges all participants to act in such a manner as to protect their own safety and the safety of others. HCBC further requires that all persons who participate in an activity to do so at their own risk and that each participant sign the following agreement, prior to taking part in the activity: I fully understand that my participation in the type of activities described herein are purely voluntary, and I desire to participate and agree to act in a reasonable and prudent manner under the circumstances. I further understand that any HCBC staff or volunteer leaders in attendance will be acting in an advisory capacity only and are not present to ensure the safety of the participants. As a condition of my participation in these activities, I waive and release HCBC, their officers, elders, employees, and agents from any claim that I may have for any damage to property or injury to my person that may result in whole or in part from participation in these activities. I the undersigned guardian of the above participation, grant HCBC staff and volunteer leaders’ authority to render judgement concerning medical assistance in the event of an accident or illness in my absence. I further agree that I will not hold HCBC financially responsible for any cost incurred related to medical assistance provided to my child. Photo/Video Release for Minors: I, as parent/guardian with legal responsibility for child/dependent, hereby grant Hill Country Bible Church Austin the perpetual right to use photographs or video taken of my child/dependent for any legitimate purpose without compensation to my child/dependent, myself, my or my child/dependent’s heirs, executor, or assigns. Legitimate purposes may include, but are not limited to, advertising on the web, in newspapers, magazines, internal publications, displayed prints, worship services, special events, curriculum, etc. *

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2022 Xtreme Adventure Registration

Cost

Cancellations/Refunds

Student Information

Parent Information

Waiver/Release

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