Winter Camp Detailed Registration Form

Winter Camp Registration
Camper's Information
Name & Surname

First NameLast Name
Birth Date

MonthDayYear
MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give consent for my child to participate in the Gway Camp Out organized by Gateway Church International from 14 to 15 June 2024. I understand that my child will be engaging in various activities during the camp, which may include but are not limited to sports, games, crafts, and worship sessions. I acknowledge that there are inherent risks associated with these activities, and I release Gateway Church International, its staff, volunteers, and affiliates from any liability for injuries or accidents that may occur during the camp.

I authorize the camp staff to seek medical treatment for my child in case of an emergency if I cannot be reached. I agree to provide all necessary medical and emergency contact information, and I will inform the camp staff of any changes to this information.

I also give permission for my child to be photographed or videotaped during the camp, and I understand that these photos/videos may be used for promotional purposes by Gateway Church International.

I have read and understood the above information and agree to its terms and conditions.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Winter Camp Registration

Camper's Information