TXM Youth Camp 2025 Leader Registration

Youth Camp 2025 Leader Registration
Thank you for serving as a leader at Youth Camp 2025, hosted by Texas Ministries Next Gen. Camp is July 12 - 16 at Boxwoods at Camp Cho-Yeh in Livingston, TX and is for students in the Class of 2025 down to those entering 7th grade this fall.

A completed registration is required for each leader serving at camp. Please note that all items indicated with an asterisk are required in order for the form to be submitted.

Leaders must be 18 years or older to serve and have graduated high school no later than 2024.

EN ESPAÑOL

Si necesita ayuda para completar este formulario en español, comuníquese con Bill Banda en ijamforhim@yahoo.com.
Leader Info
Leader's Name*

First NameLast Name
Church Name*
Sex (at birth)*

MaleFemale
Birthday*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Phone Kind*

MobileHomeWorkOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Leader T-Shirt Size:*

Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Emergency Contact's Relationship to Leader*
Spouse, Parent, Friend, Etc.
Emergency Contact's Email*
example@example.com
Emergency Contact's Phone Number*
Please enter a valid phone number.
Emergency Contact's Phone Kind*

MobileHomeWorkOther
Emergency Contact's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Insurance Information
Do you have medical insurance?*

YesNo
Insurance Company *
Name of Primary Policy Holder*

First NameLast Name
Relationship to You*
Self, Spouse, Parent, Etc.
Policy Number or Subscriber ID or Member ID*
Group ID*
Insurance Card Front: *

Cancelof
Insurance Card Back: *

Cancelof

Texas Ministries Waiver
Waiver Date*

MonthDayYear
This date will autopopulate.
This Release and Waiver of Liability (the “Release”) executed by, the undersigned (the “Attendee”), from the church name, in favor of Texas Ministries.

The attendee hereby freely, voluntarily, and without duress executes this Release under the following terms:
1. Release and Waiver. Attendee does hereby release and forever discharge and hold harmless Texas Ministries and their successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from Attendee’s Activities at any/all Texas Ministries events. Attendee understands that this Release discharges Texas Ministries from any liability or claim that the Attendee may have against the Texas Ministries with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Attendee’s Activities with the Texas Ministries. Attendee also understands that Texas Ministries does not assume any responsibility for, or obligation to, provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.
2. Medical Treatment. Attendee does hereby release and forever discharge Texas Ministries from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Attendee’s Activities with Texas Ministries.
3. Assumption of the Risk. The Attendee understands that the Activities may include recreation that normally is not considered hazardous to the Attendee, but also realizes any activity may involve possible risks. The Attendee hereby expressly and specifically assumes the risk of injury or harm in these activities and releases the Texas Ministries from all liability for injury, illness, death or property damage resulting from the Activities of the Attendee’s participation with the Texas Ministries.
4. Insurance. The Attendee understands that, except as otherwise agreed to by Texas Ministries in writing, Texas Ministries is not obligated to and does not carry or maintain health, medical, accident, car, or disability insurance coverage for any Attendee. Each Attendee is expected and encouraged to arrive with medical or health insurance coverage in effect.
5. Photographic Release. Attendee does hereby grant and convey unto Texas Ministries all right, title and interest in any and all photographic images and video or audio recordings made by Texas Ministries during the Attendee’s Activities with Texas Ministries including any photographs or recordings. Due to the large number of participants at said Activities, exemption from these photos/videos is not possible.
6. Other. Attendee expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that this Release shall be governed by and interpreted in accordance with the laws of Texas. Attendee agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
IN WITNESS WHEREOF, Attendee has executed this Release as of the day and year first above written.

Electronic Signature Authorization
By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable.
Electronic Signature

First NameLast Name
Camp Cho-Yeh/Boxwoods Waiver
Please click here to complete the Camp Cho-Yeh/Boxwoods Waiver.
Should be Empty:

	Yes	No
Tylenol
Benadryl
Ibuprofen

Youth Camp 2025 Leader Registration

Leader Info

Emergency Contact Information

Medical Info

Insurance Information

Texas Ministries Waiver

Camp Cho-Yeh/Boxwoods Waiver