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*
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*
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Gender M/F
*
T-shirt Size
*
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Participant Cell Phone Number
School Name (N/A if not applicable)
*
Completed Grade/ Position at Camp
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7
8
9
10
11
12
Youth Leader/Adult Counselor
Are there any medical conditions (i.e. allergies, epilepsy, asthma, diabetes, etc.) or medications(name/dose/times/etc.) which we should be aware of? Any Physical concerns/limitations/anything that staff should be aware of
*
Dietary Restrictions/ Food Allergies (N/A if not applicable)
*
1. Activity Supervisors
Youth Pastors Emmanuel & Isabella Cuffee, Chaperones, Youth Leaders, Volunteers and FWC Pastors & Staff.
2. Cost / Payment Information
I understand and agree that the cost of Youth Camp 2025 is $215. I understand that my camp registration will not be completed until I submit the full total payment to FWC Youth Pastors to secure the camper's reservation. Payment options are Cash and Checks (Make Checks out to "Family Worship Center" with the memo " Youth Camp" and camper's name). All Payments are Due on August 1st 2025, please submit your payments as soon as possible. Camp will be located at Mildford Bible Park from July 13th -July 17, 2025, located at 6451 Chestnut St, Zionsville, PA 18092
3. Code of Conduct
My child and I have discussed what is meant by “appropriate behavior” for church events and my child agrees to respect and to listen to the instructions of the Youth Pastors, all other pastors, youth leaders and volunteers. My child understands that valuables should not be brought to camp and are their responsibility to secure. I release Family Worship Center, its employees and its leaders/volunteers from liability in the case of lost, stolen, or damaged items brought to any meetings or trips, including camp. In the event of off-site activities, my child agrees to conduct him/herself in such a way as to appropriately represent Family Worship Center, and our Christian witness. If such conduct is not met, I will be contacted and agree to respond to the quest made by staff. If my child brings friends to camp, any meetings or events, I will instruct them of the same behavior requirements as above.
4. Requirements
The participant named above must be in 7th-12th grade or a Youth Leader, Volunteer, Adults, in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Participant, Parents/guardians should specify allergies and medical problems in sections above if not mentioned yet.
5. Leaving Church or Activity Grounds
I give permission for my child to leave the Church or Activity Grounds when supervised by the Youth Pastors for appropriate activities related to youth group (such as scavenger hunts, go for a walk or hike, concerts visit nearby coffee shops or local businesses, and etc.).
6. Consent
I, the undersigned parent/guardian, hereby consent to my child participating in Youth Camp. I understand that they will be participating in various activities, including but not limited to sports, hiking, swimming, and other outdoor activities. I acknowledge that participation in these activities involves inherent risks, including the risk of injury. I hereby release and hold harmless Family Worship Center, its staff, volunteers, and affiliates from any and all liability for any injury, loss, or damage to person or property that may occur during my child's participation in the camp.
7. Emergencies/ Medical Release
In the event of a medical emergency and when a contact cannot be made in a timely manner to me and/or the emergency contacts listed, I give my permission for me and/or my child to receive appropriate medical attention. I give permission for Family Worship Center to administer over the counter pain medication in the event of discomfort (example: Advil or Tylenol) unless notified otherwise. In the event of an unforeseen emergency or any accidents, I release Family Worship Center, its employees and volunteers, and all those related to it, from any liability. I have provided emergency contact numbers and am assured that I will be contacted as soon as possible in the event that there is an emergency.
8. General Release
I give my consent for me and/or my son/daughter to attend FWC Youth meetings, activities and events, both on site and off site. I will be updated on specific event information in advance for any activity that will betaking place off site via flyers, text, call, bulletin board posters, Facebook and etc.
9. Photo Release
I understand that photographs and videos may be taken/recorded during Youth Camp, Sunday School, Worship, Youth Group events, or other church activities. At times these photos will appear on the Advertisements, FWC website, Facebook, Google, Twitter, Instagram, and other social and public platforms. I permit and give permission to Family Worship Center to use photos that include me and/or my child and there likeness for such reasons.
I, the parent/guardian or Participant 18+ , hereby attest that I have carefully read this Permission to Participate, understand its contents, and agree to its terms and conditions.
*
I agree
Signature
Parent/Guardian Full Name (N/A if not applicable)
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
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Postal / Zip Code
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Mom's E-mail (N/A if not applicable)
*
example@example.com
Dad's E-mail (N/A if not applicable)
*
example@example.com
Home Phone Number
-
Area Code
Phone Number
Mom's Cell Phone Number (N/A if not applicable)
*
-
Area Code
Phone Number
Dad's Cell Phone Number (N/A if not applicable)
*
-
Area Code
Phone Number
10. Emergency Contacts
If, in the event of a medical or other emergency, I am unable to be reached by telephone at my home or work telephone numbers listed below, I authorize the activity supervisor(s) to attempt to contact me through the emergency contacts listed below.
Emergency Contact #1 Name
*
First Name
Last Name
Relationship
*
E-mail
*
example@example.com
Home Phone Number
-
Area Code
Phone Number
Cell Phone Number
*
-
Area Code
Phone Number
Parent Volunteer : Are you interested in volunteering as a chaperone at future youth events and meetings? If so, please check which days you are available:
Sunday School
Youth Group Weds
Youth Events/Activities
Youth Camp (Anytime)
Youth Camp (Mornings)
Youth Camp (Evenings/Nights)
I Agree that I am the Parent/Guardian of the Person/s named above and confirm that the information above is accurate and correct by Signing here.
*
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