Camp Motion 2023

Your Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail*

Address

Street Address

Street Address Line 2

CityState

Zip Code

We have paused registration for Art Camp while we confirm several in-process registrations for Art Camp. Registration for Sports Camp is still available. If you would like to put your child on a waitlist for Art Camp, please register your child for Sports Camp and include a note in the Special Needs field to that effect.

==========Information for first child==========

#1 Child's Name*

First NameLast Name

#1 Gender*

GirlBoy

#1 Age*

#1 Grade this Fall*

#1 Preferred Camp*

#1 Shirt Size*

Special Needs (all children)*

==========Information for second child==========

#2 Child's Name

First NameLast Name

#2 Gender*

GirlBoy

#2 Age

#2 Grade this Fall

#2 Preferred Camp*

#2 Shirt Size*

==========Information for third child==========

#3 Child's Name

First NameLast Name

#3 Gender*

GirlBoy

#3 Age

#3 Grade this Fall

#3 Preferred Camp*

#3 Shirt Size*

==========Emergency Contact Information==========

Emergency Contact*

First NameLast Name

Emergency Phone Number*

Area CodePhone Number

Please provide the names of anyone other than yourself who is authorized to pick up the campers.

e.g., spouse's name, grandparent's name, etc.

====================

Payment*

Pay Later with check or cashPay online now with a credit card

Pay now with a credit card

Register (1) One Child$80.00

Register (2) Two Children$160.00

Register (3) Three Children$240.00

Enter coupon

Total $0.00

Credit Card

Please mail or bring your payment to:

Wellspring Family Church

5293 South Lindbergh Blvd.

St Louis, MO 63126

The cost is $80 for one child, $160 for two children, or $240 for three children

How did you hear about us this year?*

Participation / Publicity Waivers

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Participation / Publicity Waivers

I hereby request that the child/children listed in the form above be admitted to Camp Motion and authorize and direct camp staff to exercise and act in their best judgment in the event of any medical emergency regarding the child/children. I also confirm that the child is covered by accident insurance which provides coverage for any accidental bodily injury. By accepting this waiver below, I hereby agree to hold harmless Wellspring Family Church (WFC) and any of its agents and/or employees in connection with any incident or occurrence arising out of the child’s enrollment in Camp Motion.

Camp Motion occasionally takes photos/videos of our campers for publication to our website, social media, or community media sources. By accepting this waiver below, I give permission for WFC to use pictures and/or video of the child/children listed in the form above for the above-mentioned purposes.

Neither WFC nor Camp Motion can guarantee that you, your family, or Camp Motion participants enrolled by you will not become infected with COVID-19 or any other infectious disease as a result of attending camp. You acknowledge that the WFC and Camp Motion liability insurance may not provide coverage for contracting an infectious disease. You also acknowledge the contagious nature of infectious diseases and voluntarily assume the risk that you, members of your family, and Camp Motion participants enrolled by you may be exposed to or infected as a result of attending camp and that such exposure or infection may result in personal injury, illness, permanent disability, or death.

You agree to assume all of the aforementioned risks and accept sole responsibility for any injury to yourself, Camp Motion participants enrolled by you, and members of your family, (including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, or expense of any kind) that you or they may experience or incur in connection with the use of the property or community amenities related to the property.

You hereby release and covenant not to sue, discharge, and agree to defend and hold harmless WFC and its agents and/or employees from all claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind including reasonable attorney’s fees and court costs, arising out of or relating to the contraction of COVID-19 or other infectious disease.

You understand and agree that this release includes any claims based on the actions, omissions, or negligence of WFC and Camp Motion and any of their respective employees, directors, volunteers and representatives.

By signing this form I agree to fully abide by the terms in the above waivers.*

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