BSCC J-Term Registration
January 2-4, 2025 This retreat is for anyone 18(who has graduated high school)-25 years old Please register for J-Term by filling out the registration form below. Payment for the retreat must be made at the time of registration.
Registrant Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Church
Please enter the church you attend, if you do not attend please enter NA.
Gender
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Female
Male
T-Shirt Size
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Youth Medium
Youth Large
Youth XLarge
Adult Small
Adult Medium
Adult Large
Adult XLarge
Adult 2X
Adult 3X
Signature
*
I, the Participant or the Parent/Legal Guardian of participant, being above the age of 18, agree as follows: I acknowledge and understand that certain camp activities, including but not limited to: paintball, ropes courses, archery, marksmanship, water sports, horses, zip line, rappelling, rafting, hiking, giant swing, pedal carts, rock wall, swimming and travel in camp motor vehicles or UTVs are hazardous and dangerous activities that may require strenuous exercise and varying degrees of skill and experience. I understand that these activities can result in serious injury to the person and damage to property and I voluntarily assume any and all risks of loss, damage or injury while on the premises. I acknowledge that there are risks, hazards and dangers of personal injury, death and disability inherent in entering camp grounds and participating in, or viewing camp activities. I am aware that the usual risks, hazards and dangers of personal injury, death and disability increase when using certain camping equipment and when other persons, whether of the same or different level or experience or skill, are using the same facilities and equipment. In consideration for my participation, I hereby release and forever discharge Butler Springs Christian Camp and Retreat Center and their servants, employees, officers, directors, trustees and all other persons or entities acting on their behalf (collectively referred to as “BSCC”), from any and all claims, actions, damages, liabilities, costs or expenses and attorney fees which are related to, arise out of, or are in any way connected to participation in any camping activities. By digitally signing this Agreement, it is my intention to waive any rights to sue or seek damages from BSCC; except where injury, death or disability results from BSCC gross negligence. I further agree to indemnify, hold harmless and defend BSCC against any and all claims for damages, costs, expenses or attorney’s fees brought by any third party in connection with or arising out of my, or the above-listed participant’s involvement or participation. This Agreement shall be effective and binding upon my marital community, estate, heirs, agents, personal representatives and assigns. I accept responsibility of medical coverage while at BSCC. I give BSCC permission to use photos and video of me taken at camp for promotional materials. I hereby certify that I am over 18 years of age; I have carefully read the foregoing and acknowledge that I understand and agree to all the terms and conditions. I have had the opportunity to ask any and all questions regarding this Agreement and the effect of the same. I am aware that by signing this Agreement, I assume all risks and waive and release certain substantial rights that I have or possess.
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J-Term Retreat
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95.00
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