I hereby give permission for my child to attend camp as indicated. This health history is correct as far as I know and the above listed camper has my permission to engage in all prescribed activities, except as noted by me above. I give my permission for the first aid staff to treat the above listed camper in the event of a minor illness or minor injury. IN CASE OF EMERGENCY and when I am unable to be contacted. I hereby give permission to the local physician to treat my child in the manner he recommends. I also hereby give my permission to the camp staff to inspect the contents of any or all of my child’s personal belongings and to withhold and/or dispose of any improper or illegal contents.
In consideration of my child being permitted to participate in activities at the Forts Lake Assembly of God, Inc., Summer Camp(s) located at Moss Point, MS, I release & discharge on behalf of myself and my legal representatives and assigns, the Forts Lake Assembly of God, Inc. and its board members, committees, officers, employees, directors, counselors & staff, from any and all liability including but not limited to loss and/or damage on account of injury to my person or property, even injury resulting in my death, whether caused by negligence or otherwise, while I am present on the premises of the Forts Lake Assembly of God, Inc. or participating in any activities sponsored by or connected with the Forts Lake Assembly of God, Inc Summer Camp. I assume full responsibility for risk of such injury or damage. I also certify that my child is physically fit enough to participate in camp activities. (Note any exceptions in the health statement above.) It is my intent that this release agreement is as broad and inclusive as permitted by the laws of the state of Mississippi and that it continue in full legal force and effect until I revoke it in a signed writing and provide a copy of my written revocation to Forts Lake Assembly of God, Inc.
Permission is given to Forts Lake Assembly of God, Inc. to use photographs (individual or group) and/or multimedia images and recordings in the best interest of the Forts Lake Assembly of God, Inc. Summer Camp Program.
My child and I have read the Camper Handbook Policies and Procedures and I understand my child is expected to honor all guidelines and may be suspended from camp without refund for refusal to follow the Camper Hand Book Policies and Procedures set forth.