Student Information
Signing Parent/Guardian Information
Emergency Information
(Other than the registering parent)
Activity AuthorizationAs Parent and/or Guardian ofStudent First Name* Student Last Name* (the student), I give permission for them to participate in Impact Youth Camp with First Baptist Church, Conroe, on June 17-21, 2024. I understand that my student will travel and may be in the church buses, rented vans, chartered buses, and/or in sponsor vehicles with adult chaperones. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless First Baptist Church, Conroe, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from Impact Youth Camp. *
Medical Release and AuthorizationAs Parent and/or Guardian of Student First Name Student Last Name (the student), I agree to release and hold harmless First Baptist Church, Conroe, it’s officers, directors, staff, employees, volunteers, or members, from any liability, claim or demand, of any nature, which may be incurred while participating in the above-referenced activity or during such time period. I hereby authorize any medical treatment, including, but not limited to, emergency surgery or medical treatment, and I hereby agree to assume all responsibility for any medical treatment expenses, if any. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named student, in my absence.*
Confirmation
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