M3 Camper 2024 (Sponsor Form)
Sponsor Info - Waiver Form - Medical Info - Child Protection for attendees of M3 CAMP hosted by the Southern Baptist of Texas Convention and associated Camps: (Highland Lakes Camp and Conference Center in Spicewood, Tx; Mt Lebanon Camp, in Cedar Hills, Tx; OR Glorieta Adventure Camp, Glorieta, NM)
CHURCH
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What church is bringing your camper(s) to M3 Camp?
CHURCH NAME
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Please Select
Breakout Speaker/Guest
Arise Community Church, Silver City
Bar Nun Ministries, Omaha
Believers Fellowship, Magnolia
Bellview Baptist, Midland
Benchmark Bible Church, Corinth
Bethel Baptist Church of Texas, Lewisville
Broadview Baptist Church, Abilene
Calvary Baptist Church, San Marcos
Caney Creek Baptist Church, Malakoff
Celebration Church, Montrose, CO
Central Baptist Church, Blooming Grove
Central Baptist Church, Livingston
Cherokee Baptist Church
CityView Church, Pearland
Coastal Oaks Church, Rockport
College Avenue Baptist, Levelland
College Avenue Baptist Church, McGregor
Concord Baptist Church, Waco
Cornerstone Bible Church, Decatur
Cross Church, North Richland Hills
Cross City Church, Euless
Cross Fellowship Church, Aubrey
Crosspoint Church, McKinney
Crossridge Church, Little Elm
Crosswinds Community Church
Crosswinds community church, Hobbs
East Paris Baptist Church, Paris
Emet Church, Humble
Emmanuel Baptist Church, New Caney
Emmanuel Baptist Church, Terrell
Fairview Baptist Church, Sherman
Faith Family Baptist Church, Kingwood
FBC Archer City
FBC Benbrook
FBC Childress
FBC Hamlin
FBC Jayton
FBC Kemp
FBC Savoy
FBC Sudan
FBC Taylor
Fellowship of the Parks, Fort Worth
Field Street Baptist Church, Cleburne
First Baptist, Buna
First Baptist, Malakoff
First Baptist, Whitewright
First Baptist, Belton
First Baptist Church, Tomball
First Baptist Church, Farmersville
First Baptist Church, Farwell
First Baptist Church, Friona
First Baptist Church, Iowa Park
First Baptist Church, Kerens
First Baptist Church, Rogers
First Baptist Church, Corinth
First Baptist Church, Groesbeck
First Baptist Church of Hawkins
First Baptist Church of Jayton
First Baptist Church of Lavon
First Baptist Church of Lillian
First Baptist Church Tahoka
First Baptist Edinburg
First Baptist Fredericksburg
First Baptist Silsbee
First Baptist Whitewright, Whitewright
FiveStone Community Church, Garland
Flower Mound First Baptist, Flower Mound
Fredonia Hill Baptist Church, Nacogdoches
Freedom Fellowship, Roanoke
Freedom Hill Church, San Antonio
Gateway Baptist Church, Tuscola
Gateway Community Church, Wylie
Genuine Faith Community Church, Greenville
Grace Baptist Grandview
Grace Community, Corsicana
Gracepointe, Denton
Great Hills Baptist Church, Austin
Harvey Baptist Church, Stephenville
Heights Baptist Church, Alvin
Hillcrest Baptist Church, Bryan
Hope Church, Montgomery
Hope Church, Kyle
Iglesia Agape, Fort Worth
Island Baptist Church, South Padre Island
Junction First Baptist, Junction
Lakeland Baptist Church, Lewisville
Legacy Hills Church, Celina
Living Water Christain Fellowship, Canyon
Meadowbrook Baptist Church, Rockdale
New Day Church, Pasadena
North Park Baptist, Sherman
Paramount Baptist Church, Amarillo
Point View Baptist Church
Porter First Baptist Church
Redeemer Church, Tomball
Renewed Life Baptist Church, Gladewater
Roby FBC
Second Baptist, Andrews
Southlake Baptist Church
Spring Baptist Church
Spring Creek Baptist Church
Stonegate Church Midlothian
Summer Grove Baptist Church, Shreveport, LA
Talty Baptist Church, Crandall
Tate Springs Baptist Church, Arlington
The church at Quail Creek, Amarillo
The River, Channelview
Trinity Baptist Church, Amarillo
Trinity Baptist Church, Mt. Pleasant
Vantage Point Church, Haslet
Vista Grande Baptist Church, Colorado Springs
Waves of Faith, Fort Worth
Western Hills Baptist, Wichita Falls
Whitharral Baptist Church
What church is bringing your camper(s) to M3 Camp?
GROUP LEADER NAME
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First Name
Last Name
Which camp are you attending?
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Mt. Lebanon May 28-June 1
Highland Lakes July 1-5
Highland Lakes July 8-12
Glorieta July 11-15
GROUP LEADER EMAIL
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Sponsor - Name
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First Name
Last Name
SPONSOR - Email
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example@example.com
Camper Profile Picture
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Sponsor - Biological Sex:
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Male
Female
Camper - Date of Birth
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DD/MM/YYYY
Camper - Shirt Size:
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S
M
L
XL
XXL
XXXL
Emergency Contact - Name
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First Name
Last Name
Emergency Contact - Email
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Emergency Contact - #
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Please enter a valid phone number.
Emergency Contact relation to Sponsor
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Mother, Father, Guardian, etc
SPONSOR SIGNATURE AGREEMENT TO ATTEND, PARTICIPATE, ASSUMPTION OF RISK AND RELEASE OF LIABILITY: I, am/are fully informed about and aware at the attending camp (Highland Lakes Camp and Conference Center in Spicewood, Tx; OR Mt Lebanon Camp in Cedar Hill Texas; OR Glorieta Adventure Camp, Glorieta NM) in connection with an event of the Southern Baptist of Texas Convention (SBTC), certain risks and dangers will occur. These include, but are not limited to, the hazards that raise from being in a wilderness area, the forces of nature and other hazards arising out of the content of this program which include, but are not limited to, volleyball, softball, basketball, archery range, wilderness hiking, swimming, use of water crafts, and a challenge course which has a climbing wall, zip lines, high and low elements, and a team power pole. In consideration of the attending camp (Highland Lakes Camp and Conference Center in Spicewood, Tx; OR Mt Lebanon Camp in Cedar Hill Texas; OR Glorieta Adventure Camp, Glorieta NM) and the SBTC providing and my willingness to engage in these rigors activities and a special environment, I have and do hereby hold the attending camp (Highland Lakes Camp and Conference Center in Spicewood, Tx; OR Mt Lebanon Camp in Cedar Hill Texas; OR Glorieta Adventure Camp, Glorieta NM) and the SBTC their owners, officers, directors, trustees, agents, employees, and/or volunteers, harmless from any and all claims, liabilities, suits, actions, causes, damages, or losses and demands of every kind and nature whatsoever, including with limitation, all costs and attorney fees, which may arise from or in connection with my stay or participation in any activities arranged for or by the attending organization or group leaders, the attending camp (Highland Lakes Camp and Conference Center in Spicewood, Tx; OR Mt Lebanon Camp in Cedar Hill Texas; OR Glorieta Adventure Camp, Glorieta NM), or SBTC. Injuries may include, but are not limited to emotional injuries, physical injuries, or death. The terms hereby shall serve as a release and assumption of risk for my heirs, executors, administrators, and for all family members of mine. SPONSOR SIGNATURE
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Sponsor Printed Name and Date
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Printed Name
Date of Signature
Parent/Gaurdian Printed Name and Date
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Printed Name
Date of Signature
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SPONSOR MEDICAL - Family Physician
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SPONSOR MEDICAL - Insurance Co
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SPONSOR MEDICAL - Plan or Group #
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SPONSOR MEDICAL - Insured ID # or Member #
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SPONSOR MEDICAL - Ins. Co. Phone
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SPONSOR MEDICAL - List any and all allergies for the minor:
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Allergies: Food, Insect, Medicine, Drug, Plant, Pollen, other
SPONSOR MEDICAL - List any and all dietary restrictions:
Allergies: Food, Insect, Medicine, Drug, Plant, Pollen, other
SPONSOR MEDICAL - List any recent or major surgeries:
Allergies: Food, Insect, Medicine, Drug, Plant, Pollen, other
SPONSOR MEDICAL - Disease, Chronic, or Recurring illness (check all that apply):
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Asthma
Bleeding Disorder
Dermatological Condition
Diabetes
Ear Infections
Heart Defects
Seizures
Stomach Conditions
Emotional
None
SPONSOR MEDICAL - Elaborate on any above medical conditions. Please provide any information to assist medical attention (if needed):
Allergies: Food, Insect, Medicine, Drug, Plant, Pollen, other
SPONSOR MEDICAL - Approved medications for minor to receive by medical provider:
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Acetaminophen (ie Tylenol)
Antihistamine (ie Benadryl, Claritin)
Antacid tablet (ie Tums)
Ibuprofen (ie Advil)
Antihistamine Cream
Decongestant (ie Sudafed)
Antibacterial ointment
Additional medications (check here AND comment below)
SPONSOR MEDICAL - Any additional medications
MEDICAL PERMISSION: By signing, I give permission for the first aid techniques and simple health care to be administered as the need arises. I understand in the event of any serious injury or illness on my part, the camp officials, reserve the right to see professional medical attention including but not limited to consultation with a medial director, EMS Transportation, and hospitalization. Furthermore, I give permission for the attending camp (Highland Lakes Camp and Conference Center, Mt Lebanon Camp, OR Gloireta Adventure Camp) in consultation with the Camp Heath Supervisor and/or medical director's standing orders to be given the above approved medications. ATTEST ACCURATE MEDICAL INFORMATION: By signing, I hereby attest all information listed above as SPONSOR MEDICAL is complete and accurate to the best of my knowledge, that I am in acceptable health, physical ability, and emotionally ready to fully participate in all camp actives. In addition, I am willing only to participate in all activities associated with the enrolled event with exceptions of those that are noted. Lastly, I give permission for Highland Lakes Camp and Conference Center, Mt Lebanon Camp, Glorieta Adventure Camp management, medical staff, and/or group director to provide medical treatment that may be deemed necessary to insure my well-being. I do hereby release and forever discharge all from any and all claims, demands, actions, or cause of action arising out of damage or injury while participating the attending camps (Highland Lakes Camp and Conference Center in Spicewood, Tx; OR Mt Lebanon Camp in Cedar Hill Texas; OR Glorieta Adventure Camp, Glorieta NM) and SBTC sponsored activities. SPONSOR SIGNATURE
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SPONSOR Printed Name and Date
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Printed Name
Date of Signature
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Ministry Safe (or Equivalent Child Protection Certification)
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I completed a Ministry Safe certification with the SBTC within the last 2 years.
I completed a child protection certification with my attending church within 2 years of the upcoming (July of 2022).
I have NOT completed child protection certification.
I am unsure if I have a child protection certification on file with my local church or the SBTC.
Background Check
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I completed a background check with the SBTC (post July 2022).
I have a valid background check on file with my attending church (post July 2022)
I do NOT have a background on file with my local church or the SBTC.
I am unsure if I have a valid background check on file with the my local church or the SBTC.
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