Clone of Summer Camp Permission Form

Summer Camp 2024: Experience Him

Hosted by Mesa Baptsit Church
Consent and Release
I, the undersigned parent or legal guardian, hereby consent to my child participating in the following activity sponsored by Mesa Baptist Church.

If my child has a medical condition, which may be relevant to a physician in the event of an emergency, I have listed them below. If I cannot be reached, I hereby authorize the adult sponsor of this activity to make major medical decisions for my child. If there are any activities I do not want my child to be involved in, I have listed them below.

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID AVTIVITY, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold Mesa Baptist Church and it’s agents and employees, harmless from any and all liability, actions, caused of actions, claims expenses, and damages on account of injury to my child or property, even injury resulting in death, which I how have or which may rise in the future in connection with the activity or participation in any other associated activities.

I expressly agree that this release, waiver and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of New Mexico and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not mere recital.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I have read and understand.
Camper's Full Name*

First NameLast Name
Camper's Birth Date*

MonthDayYear
T-shirt Size
Home Church*
Grade Completed*
Child's Allergies or Medical Problems*
Medication To Be Aware Of
Parent/ Guardian Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Legal Guardian's E-mail*
example@example.com
Legal Guardian's Phone Number
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 Name*

First NameLast Name
Relationship*
E-mail*
example@example.com
Emergency Contact Phone Number
I, the parent/guardian, hereby attest that I have carefully read this Permission to Participate, understand its contents, and agree to its terms and conditions.*

I agree
Signature

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Parent Signature
Date*

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Date
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Summer Camp 2024: Experience Him

Consent and Release

Emergency Contacts