Base Camp 2025 Liability Waiver Form

Base Camp 2025 Liability Waiver Form

Let's get your student to camp! Fill out the form below, and they'll be all set to go!
Name of Student*

First NameLast Name
Student's Grade in Fall 2025*
Name of Parent/Guardian Completing the Waiver*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent/Guardian's Phone Number*
Parent/Guardian's Email*
example@example.com
Secondary Contact*

First NameLast Name
Secondary Phone Number*
Please enter a valid phone number.
Known Allergies/Dietary Restrictions of Student:*
Special Medical History of Student:*
PLEASE READ THIS DOCUMENT CAREFULLY. IT CONTAINS A RELEASE LIABILITY AND A PROMISE TO INDEMNIFY.

The undersigned Parent or Legal Guardian, hereinafter called Guardian, hereby gives permission to Lake Valley Community Church, a nonprofit Church Corporation organized and existing under the laws of Arkansas with its principal office located at 910 Shady Grove Road, Hot Springs, AR 71901, referred to herein as the Church, for my Child (hereinafter referred to as the "Child" or "Student") to take part in Base Camp 2025 Weekend Retreat.

Should my Child require immediate or emergency medical care while engaged in the aforesaid activity sponsored by the Church, in my absence, I hereby grant the Church authority to release my Child for medical treatment to such medical personnel as the Church determines appropriate under the circumstances.

In consideration for the privilege of allowing my Child to participate in the activity described above, I release and hold harmless the Church, its officers and agents, from any liability to or responsibility for bodily injury, damage or illness to the Child while participating in the aforesaid activity.

Further, I agree to indemnify and hold harmless the Church, its officers and agents with respect to any claim asserted by or on behalf of my Child as a result of bodily injury, illness, or damage.

Additionally, I grant permission to Lake Valley Community Church to take and use photographs and/or digital images and videos of my Child for use in their publications, promotions, website, and/or social media. I understand that my Child's name will not be revealed unless agreed to by a parent or legal guardian of the Child. I authorize the use of these images without compensation.
Signature of Parent/Guardian

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Date signed by Parent/Guardian*

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Date
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