• Living River Fall Elementary Retreat 2026- Child Registration Form

    Pressing the "back" button of your browser will reload the form, so only use the "back" and "next" buttons at the bottom of the form pages. Once you click "submit" you cannot go back to edit your submission, but the "save" option is great if you need to take a pause in filling out the form. A copy of your submission should be emailed to you. There is a separate form for adult chaperones. We're looking forward to the Fall Elementary Retreat! Email office@livingriver.org with any questions. Thank you!
    • Camper One's Personal Information 
    • Gender*

    • Camper One's Medical Information

    • Does the camper have any allergies?*
    • Does the camper have any dietary restrictions?*
    • Does the camper have any chronic illness or conditions?*
    • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
    • Check all over-the-counter medications that our healthcare provider may give your camper as needed:*
    • Is your camper up to date on the immunizations required for public school?*

    • Camper One's Family Information

    •  -

    • Camper One's Emergency Contact Information

      Living River will attempt to contact the parent/ guardian first. Please provide an emergency contact who is not the same as the parent/ guardian listed above and who will not be attending the retreat.
    •  -
    •  -

    • Camper One's Healthcare Provider

    •  -

    • Camper One's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof
    • Take a photo of the front of your card.

  • Camper Two's Personal Information

  • Gender*

  • Camper Two's Medical Information

  • Does the camper have any allergies?*
  • Does the camper have any dietary restrictions?*
  • Does the camper have any chronic illness or conditions?*
  • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
  • Check all over-the-counter medications that our healthcare provider may give your camper as needed:*
  • Is your child up to date on the immunizations required for public school?*

  • Camper Two's Family Information

  • Is your second camper's family information (church, parent/guardian, emergency contact, healthcare provider, insurance) the same as your first's?*
    • Copy of Camper One's Family Information 
    • Camper Two's Family Information 
    •  -

    • Camper Two's Emergency Contact Information

      Living River will attempt to contact the parent/ guardian first. Please provide an emergency contact who is not the same as the parent/ guardian listed above and who will not be attending the retreat.
    •  -
    •  -

    • Camper Two's Healthcare Provider

    •  -

    • Camper Two's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof
    • Take a photo of the front of your card.

  • Camper Three's Personal Information

  • Gender*

  • Camper Three's Medical Information

  • Does the camper have any allergies?*
  • Does the camper have any dietary restrictions?*
  • Does the camper have any chronic illness or conditions?*
  • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
  • Check all over-the-counter medications that our healthcare provider may give your camper as needed:*
  • Is your child up to date on the immunizations required for public school?*

  • Camper Three's Family Information

  • Is your third camper's family information (church, parent/guardian, emergency contact, healthcare provider, insurance) the same as your first two's?
    • Copy of Camper One's Family Information 
    • Camper Three's Family Information 
    •  -

    • Camper Three's Emergency Contact Information

      Living River will attempt to contact the parent/ guardian first. Please provide an emergency contact who is not the same as the parent/ guardian listed above and who will not be attending the retreat.
    •  -
    •  -

    • Camper Three's Healthcare Provider

    •  -

    • Camper Three's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof
    • Take a photo of the front of your card.

  • Camper Four's Personal Information

  • Gender*

  • Camper Four's Medical Information

  • Does the camper have any allergies?*
  • Does the camper have any dietary restrictions?*
  • Does the camper have any chronic illness or conditions?*
  • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
  • Check all over-the-counter medications that our healthcare provider may give your camper as needed:*
  • Is your child up to date on the immunizations required for public school?*

  • Camper Four's Family Information

  • Is your fourth camper's family information (parent/guardian, emergency contact, healthcare provider, insurance) the same as your first three's?
    • Copy of Camper One's Family Information 
    • Camper Four's Family Information 
    •  -

    • Camper Four's Emergency Contact Information

      Living River will attempt to contact the parent/ guardian first. Please provide an emergency contact who is not the same as the parent/ guardian listed above and who will not be attending the retreat.
    •  -
    •  -

    • Camper Four's Healthcare Provider

    •  -

    • Camper Four's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof
    • Take a photo of the front of your card.

  • Camper Five's Personal Information

  • Gender*

  • Camper Five's Medical Information

  • Does the camper have any allergies?*
  • Does the camper have any dietary restrictions?*
  • Does the camper have any chronic illness or conditions?*
  • Does the camper have any prescribed medication, an inhaler, or an epinephrine injection device (EpiPen)?*
  • Check all over-the-counter medications that our healthcare provider may give your camper as needed:*
  • Is your child up to date on the immunizations required for public school?*

  • Camper Five's Family Information

  • Is your fifth camper's family information (parent/guardian, emergency contact, healthcare provider, insurance) the same as your first four's?
    • Copy of Camper One's Family Information 
    • Camper Five's Family Information 
    •  -

    • Camper Five's Emergency Contact Information

      Living River will attempt to contact the parent/ guardian first. Please provide an emergency contact who is not the same as the parent/ guardian listed above and who will not be attending the retreat.
    •  -
    •  -

    • Camper Five's Healthcare Provider

    •  -

    • Camper Five's Insurance Information

    • Upload a copy or take a picture of your insurance card below:

    • Browse Files
      Cancelof
    • Take a photo of the front of your card.

  • Living River Consent Agreements

    The consent forms below apply to all children registered on this form. If that's an issue or you have any questions, please email office@livingriver.org. Living River's Medical and Liability Releases are required for participation and for submitting this form. If for some reason, you cannot accept these releases, please email office@livingriver.org. Payment for all participants, child and/or adult chaperones, will be handled through each congregation or through PayPal invoicing if attending apart from a congregation.

  • Living River: A Retreat on the Cahaba, Inc. Participant Photo and Media Release

    I understand that photos of my child or me may be used by Living River for publicity purposes in print or on social media. Names will not be printed. If I do not wish photographs of my child to be used in this capacity I will notify staff, in writing, before the beginning of the camp session. 

  • Please Select:*

  • Living River: A Retreat on the Cahaba, Inc. Participant Medical Release

    I, the undersigned, understand that I will be notified in case of medical or surgical emergency involving my child. However, in the event that I or persons I have designated cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. I understand Living River will not be responsible for medical expenses incurred, but that such expenses will be my responsibility as parent/guardian. I will notify the camp director of any problems or restrictions which would affect participation in normal camp activities prior to the camp period. I also understand that the adult supervisors reserve the right to restrict my child from any activity that they do not feel is within the physical capabilities of my child. I agree to abide by the decisions of the director(s) in the case of sending the camper home due to illness or fails to abide by the camp rules.

  • Living River: A Retreat on the Cahaba, Inc. Participant Release of Liability and Assumption of Risk Agreement

    In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that: 

    1. The risk of injury from activities involved in this program is significant, including the potential for permanent paralysis and death. 

    2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation. 

    3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. 

    4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS LIVING RIVER: A RETREAT ON THE CAHABA INC., its officers, officials, agents and/or employees, other participants, volunteers, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law. 

    5. I will abide by all local, state, and federal guidelines or laws.

    For Parents/Guardians of Participants(s) of Minor Age (under age 18)- I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. 

  • Your electronic signature below affirms the validity of the information on this form and is equally as binding as an original, manual signature. Your signature applies the above consent releases to every camper you have registered.

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