TCC All Camper Registration Form

Registration Form
Type of Registration

FamilyAdult OnlyMinor Day CampMinor Overnight
Parent/Guardian/Adult Camper Information
Parent/Guardian/Adult Name 1*

First NameLast Name
Parent/Guardian/Adult 1 Mobile Phone*
Please enter a valid phone number. Note: Phones may be taken up during service times.
Email*
example@example.com
Parent/Guardian/Adult 2

First NameLast Name
Parent/Guardian/Adult 2 Mobile Phone
Please enter a valid phone number. Note: Phones may be taken up during service times.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Where will you be staying on-site (hall/room or camper number)?
Emergency Contacts

Emergency Contact 1
Emergency Contact Name

First NameLast Name
Emergency Contact Mobile Phone
Please enter a valid phone number.
Relationship to Camper

Church Information
Church Name
City/State

Street Address

Street Address Line 2

CityState

Zip Code

Family Insurance Information
Do you have health insurance?*

YesNo
Insurance Data

CHILDREN’S & TEEN PERMISSION FORM

Dorm/Photo/Swimming Release
DORM LODGING

(Only for youth residing in dorms)
I give permission for my child(ren) to reside in a dormitory during the annual encampment at Taylor County Camp Meeting. I understand that there will be adult supervision.

YesNo
SWIMMING ACTIVITIES
I give permission for my child(ren) to go swimming with other campers, understanding that there will be adult supervision. I also understand that there will NOT be a certified lifeguard on duty.

YesNo
PHOTO AND VIDEO RELEASE
I consent to the taking of photographs and/or video of the minor(s) listed on this form and release Taylor County Camp to use said photos/videos for non‐profit purposes including use in print, on the internet, and all other forms of media.

YesNo

Participant Waiver
ADULT PARTICIPANT WAIVER, RELEASE, INDEMNIFICATION OF ALL CLAIMS & COVENANT NOT TO SUE

I am over the age of eighteen, and I am fully competent to sign this Release. I certify that I am in good health, have no mental or physical conditions that would prevent my participation in the encampment and/or its recreation activities, and have no condition that requires the taking of medication on a regular basis, except as fully and expressly indicated above. In consideration of being permitted to participate in the Taylor County Holiness Campground, Inc.’s (the “Camp’s”) activities and to use the facilities and equipment at the Camp, I, on behalf of myself and my representatives, executors, heirs, next of kin, administrators, beneficiaries, successors and assigns (collectively, “my Representatives”), hereby agree to be bound by this Release. I understand that such participation or use entails certain inherent risks, and I, on behalf of myself and my Representatives, voluntarily accept all risk to my health that may result from such participation or use. Therefore, I, on behalf of myself and my Representatives, hereby agree that Taylor County Holiness Camp Ground, Inc., its directors, officers, employees, agents, representatives, related and/or affiliated entities, successors and assigns (hereinafter, “Released Parties”) SHALL NOT BE LIABLE FOR ANY DAMAGES arising from (a) the DISCLOSURE OF MEDICAL INFORMATION contained in this form (if believed necessary by the Released Parties), and/or (b) PERSONAL INJURIES (INCLUDING DEATH), DAMAGE TO OR LOSS OF PROPERTY OR OTHER HARM, whether foreseen or unforeseen, present or future, known or unknown, that I may sustain in any way which directly or indirectly results from or arises from my attendance or participation in the Camp. Furthermore, I, on behalf of myself and my Representatives, agree to INDEMNIFY, DEFEND, AND HOLD HARMLESS the Released Parties from and against any and all claims, foreseen or unforeseen, present or future, known or unknown, that I or my Representatives may have or assert, even if caused in whole or in part by the NEGLIGENCE, FAULT, BREACH OF CONTRACT, STRICT LIABILITY, OR OTHER ACT, CONDUCT OR STATUS of any of the Released Parties. This indemnification includes all costs of defending such claims, including attorneys’ fees, costs, and expenses, whether suit is filed or not. I further authorize emergency medical treatment to be performed by Camp medical staff and/or attending physicians at the local clinic or hospital to me as they deem necessary. This Release contains the entire agreement between the parties and may be amended only in writing signed by the undersigned and the Released Parties’ representative(s), or their successors. It is not intended to release the Released Parties from any conditions or activity that, as a matter of law, cannot be avoided, waived or released, and no provision hereof should be so interpreted. It is governed by the internal laws of Georgia (even if applicable conflict of law rules would provide otherwise). Its terms are severable. It shall not be strictly construed against any party. I HAVE READ AND UNDERSTAND THIS RELEASE AND ACCEPT AND AGREE TO ITS TERMS AND SIGN IT VOLUNTARILY.
MINOR PARTICIPANT WAIVER, RELEASE, INDEMNIFICATION OF ALL CLAIMS & COVENANT NOT TO SUE

I am a parent or legal guardian of the Minor named above who is under eighteen years of age (“Minor”), and I am fully competent to sign this Release. I certify that Minor is in good health, has no mental or physical conditions that would prevent his or her participation in the encampment and/or its recreation activities, and has no condition that requires the taking of medication on a regular basis, except as fully and expressly indicated above. In consideration of Minor being permitted to participate in Taylor County Holiness Campground, Inc.’s (the “Camp’s”) activities and to use the facilities and equipment at the Camp, I, on behalf of myself, Minor, and Minor’s representatives, executors, heirs, next of kin, administrators, beneficiaries, successors and assigns (collectively, the “Minor’s Representatives”), hereby agree to be bound by this Release. I understand that such participation or use entails certain inherent risks to Minor, and I, on behalf of Minor’s Representatives, voluntarily accept all risk to Minor’s health that may result from such participation or use. Therefore, I, on behalf of Minor’s Representatives, hereby agree that Taylor County Holiness Camp Ground, Inc., its respective directors, officers, employees, agents, representatives, related and/or affiliated entities, successors and assigns (hereinafter, “Released Parties”) SHALL NOT BE LIABLE FOR ANY DAMAGES arising from (a) the DISCLOSURE OF MEDICAL INFORMATION contained in this form (if believed necessary by the Released Parties), and/or (b) PERSONAL INJURIES (INCLUDING DEATH), DAMAGE TO OR LOSS OF PROPERTY OR OTHER HARM, whether foreseen or unforeseen, present or future, known or unknown, that Minor may sustain in any way which directly or indirectly results from or arises from Minor’s attendance or participation in the Camp. Furthermore, I, on behalf of Minor’s Representatives, agree to INDEMNIFY, DEFEND, AND HOLD HARMLESS the Released Parties from and against any and all claims, foreseen or unforeseen, present or future, known or unknown, that Minor’s Representatives may have or assert, even if caused in whole or in part by the NEGLIGENCE, FAULT, BREACH OF CONTRACT, STRICT LIABILITY, OR OTHER ACT, CONDUCT OR STATUS of any of the Released Parties. This indemnification includes all costs of defending such claims, including attorneys’ fees, costs, and expenses, whether suit is filed or not. I further authorize emergency medical treatment to be performed by Camp medical staff and/or attending physicians at a local clinic or hospital to my child in my absence. This Release contains the entire agreement between the parties and may be amended only in writing signed by the undersigned and the Released Parties’ representative(s), or their successors. It is not intended to release the Released Parties from any conditions or activity that, as a matter of law, cannot be avoided, waived or released, and no provision hereof should be so interpreted. It is governed by the internal laws of Georgia (even if applicable conflict of law rules would provide otherwise). Its terms are severable. It shall not be strictly construed against any party. I HAVE READ AND UNDERSTAND THIS RELEASE AND ACCEPT AND AGREE TO ITS TERMS AND SIGN IT VOLUNTARILY.
NOTICE: THIS IS A LEGALLY BINDING AGREEMENT.

Read this document carefully and in entirety. By signing this agreement, you give up your right and the named minor’s right to bring a court action to recover compensation or obtain any other remedy for any personal injury or property damage however caused arising out of the named minor’s participation in Taylor County Holiness Camp programs, now or any time in the future.
I HAVE READ AND UNDERSTAND THIS RELEASE AND ACCEPT AND AGREE TO ITS TERMS AND SIGN IT VOLUNTARILY.*

Yes
I understand that my camp registration is NOT confirmed until my payment has been received in full by the due date.*

Yes
Signature*

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Registration Form

Parent/Guardian/Adult Camper Information

Emergency Contacts

CHILDREN’S & TEEN PERMISSION FORM

DORM LODGING

SWIMMING ACTIVITIES

PHOTO AND VIDEO RELEASE

Participant Waiver