2026 Blend Out Performing Arts Camp Registration Form

BLEND OUT LOUD PERFORMING ARTS CAMP REGISTRATION FORM 2026

Bible Way Church of Atlas Road 2440 Atlas Road, Columbia, SC 29209
CAMPER INFORMATION
Name

First NameLast Name
Birth Date

MonthDayYear
Age
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Rising Grade Level
Name of School
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name

First NameLast Name
Relationship to Child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
T-SHIRT SIZE

The Blend Out Performing Arts Camp T-Shirts are not included in the camp registration.
YOUTH
ADULT
MEDICAL INFORMATION

Check the boxes of immunizations that have been obtained and are current:
Immunizations
List any unusual conditions the camp staff should know about (allergies, medications, medical conditions, restrictions, limitations, etc.)
Camper's Physician Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Office Number

Area CodePhone Number
BLEND OUT PERFORMING ARTS CAMP JULY13th-17th
This part of the application is to be completed and signed by a parent or guardian. Where parents are separated or divorced, this form must be signed by the parent with legal custody as established by a court.

I hereby certify that the above applicant is in good physical health and to my knowledge has no medical and/or physical conditions that would prohibit him/her from participating in any of the activities. I have read all the information in this application and I understand that the camper(s) will be supervised by the camp staff and that if serious injury or illness occurs, medical and/or hospital care will be given.

I further understand that in case of serious injury or illness an attempt will be made to notify the parent or guardian from the information furnished in this form. If it is impossible to reach the parent or guardian, I give my permission for treatment or surgery to be administered as recommended by the attending physician.

I / we acknowledge that the applicant knows and is well aware of the risks and dangers involved in the above Summer Camp Program and are assuming all risks of the injury and damage incidents to his/her participation in the camp. Further, in consideration of the permission granted to the applicant to participate in the BLEND OUT LOUD PERFORMING ARTS CAMP 2026 I / we do hereby release and discharge the BLEND OUT LOUD PERFORMING ARTS CAMP 2026 BLEND OUT LOUD, THE MIDLANDS COMMUNITY DEVELOPMENT CENTER, THE BIBLE WAY YOUTH & CHILDREN DEVELOPMENT CENTER AND THE BIBLEWAY CHURCH OF ATLAS RD from all claims, demands, actions and causes of action of any kind for any injuries sustained by the applicant and from any damages to applicant and/or applicant’s property as a result of the camp activities which will include, but not be limited to, displays, career-oriented classes, and all summer camp and other recreational activities.
PARENT CONSENT AND RELEASE FORM
This part of the application is to be completed and signed by a parent or guardian. Where parents are separated or divorced, this form must be signed by the parent with legal custody as established by a court.

I hereby certify that the above applicant is in good physical health and to my knowledge has no medical and/or physical conditions that would prohibit him/her from participating in any of the activities. I have read all the information in this application and I understand that the camper(s) will be supervised by the camp staff and that if serious injury or illness occurs, medical and/or hospital care will be given.

I further understand that in case of serious injury or illness an attempt will be made to notify the parent or guardian from the information furnished in this form. If it is impossible to reach the parent or guardian, I give my permission for treatment or surgery to be administered as recommended by the attending physician.

I / we acknowledge that the applicant knows and is well aware of the risks and dangers involved in the above Summer Camp Program and are assuming all risks of the injury and damage incidents to his/her participation in the camp. Further, in consideration of the permission granted to the applicant to participate in the BLEND OUT LOUD PERFORMING ARTS CAMP 2026 I / we do hereby release and discharge the BLEND OUT LOUD PERFORMING ARTS CAMP 2026 BLEND OUT LOUD, THE MIDLANDS COMMUNITY DEVELOPMENT CENTER, THE BIBLE WAY YOUTH & CHILDREN DEVELOPMENT CENTER AND THE BIBLEWAY CHURCH OF ATLAS RD from all claims, demands, actions and causes of action of any kind for any injuries sustained by the applicant and from any damages to applicant and/or applicant’s property as a result of the camp activities which will include, but not be limited to, displays, career-oriented classes, and all summer camp and other recreational activities.
PHOTO/MEDIA RELEASE

Do you give your child permission to be photographed during the camp for promotional purposes? Please check your answer in the box below.
PHOTO/MEDIA RELEASE
PICK UP

Please provide alternate authorized individuals to pick up your child(ren).
Name and Phone Number
Name and Phone Number
I HAVE READ AND UNDERSTAND THE FOREGOING CONSENT AND RELEASE FORM AND REQUEST THAT THE ABOVE APPLICANT BE PERMITTED TO ATTEND THE CAMP SUBJECT TO THE ABOVE TERMS AND CONDITIONS.

I HEREBY CERTIFY THAT THE ABOVE NAMED STUDENT HAS BEEN APPROVED TO ATTEND THE BLEND OUT PERFORMING ARTS CAMP ONLINE AND IN-PERSON.
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Blend Out Loud Performing Arts Camp For 1$100.00
The Blend Out Loud Performing Arts Camp will be held July 13th-17th on the campus of the Bible Way Church of Atlas Rd. at 2440 Atlas Rd. Columbia, SC. The hours of the camp span from 8:30 A.M. to 5:00 P.M. Our concert for the community take place on Friday, July 17th at 6:15 P.M.

Total $0.00
Please type your name below as your signature.
First Name
Last Name
Date
E-Signature
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BLEND OUT LOUD PERFORMING ARTS CAMP REGISTRATION FORM 2026

CAMPER INFORMATION

PARENT/GUARDIAN INFORMATION:

T-SHIRT SIZE

BLEND OUT PERFORMING ARTS CAMP JULY13th-17th

PARENT CONSENT AND RELEASE FORM

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