Camp 2026 ADULT CHAPERONE Registration Form

Name

Last NameFirst Name

Birth Date

MonthDayYear

Gender

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

T-Shirt Size (Adult Sizes)

Will you be riding the bus to camp?

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you have a student or child attending camp with you?

6th grade and under must be accompanied by a parent.

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Do you have any allergies, chronic illness, or medical conditions? If yes, please describe.

Are you prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for participation in any and all activities prepared by FBC Ft. Ogden during the selected camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless FBC Ft. Ogden, and all its respective officers, agents, and representatives from any and all liability for injuries arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury, I hereby waive all claims against FBC Ft. Ogden, including all staff, volunteers, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or surgical treatment, x-ray examination and immunizations.

Permission is also granted to FBC Ft. Ogden . and its affiliates including staff, volunteers, and leaders to provide the needed emergency treatment prior to the medical facility.

Release authorized on the dates and/or duration of the registered week.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb.

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

Signature

Camp 2026 Registration

Camper Information