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SIGNATURE EVENT WAIVER
Camp activities include strenuous outdoor activities and out of camp travel in camp vehicles. As with most activities in life, there is an inherent risk in participating in these activities. By signing below you are indicating that you understand the risk involved in camp activities and you are willing to participate in all activities. All activities are well-supervised, with an emphasis on safety.
Email
*
example@example.com
Guest/Camper Name
*
First Name
Last Name
Start Date of Event
*
-
Month
-
Day
Year
Date
End Date of Event
*
-
Month
-
Day
Year
Date
Event Name
*
Please Select
Teen Camp 1 (July 1-5)
Teen Camp 2 (July 8-12)
Day Camp (June 17-21)
Junior Camp (June 17-21)
T-Shirt Size
Please Select
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Adult X Large
Adult XX Large
Adult XXX Large
Group Name
*
Please Select
Beech Park
Bible BC
Bible BC VA
Central BC
Edgemont Junior
Edgemont Teens
Enon
Fairview
FBC Pikeville
Floyd Rd Junior
Floyd Rd Teens
Friends BC
Friendship BC
Gethsemane
New Home
Southside
West Huntsville
Other/Individual
Gender
*
Male
Female
Any Food Allergies?
*
Yes
No
Food Allergies
*
Please list any food allergies you/your camper have.
Which Activity Waiver Form do you need?
*
Adult (aged 21 or older)
Minor (aged 20 or younger)
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SIGNATURE EVENT WAIVER
ADULT
Contact Information
For Adults aged 21 or older
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
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Emergency Contact
Emergency Contact
*
First Name
Last Name
Emergency Phone
*
-
Area Code
Phone Number
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Permission
Camp activities include strenuous outdoor activities and out of camp travel in camp vehicles. As with most activities there is an inherent risk in participating in these activities. IT IS MANDATORY THAT THIS FORM IS FILLED OUT, SIGNED, DATED, AND RETURNED BY YOU. YOU WILL NOT BE PERMITTED TO STAY AS OUR GUEST UNLESS WE HAVE RECEIVED THIS FORM. A copy of this form will be emailed to you upon completion.
Legal Name
*
First Name
Last Name
Signature
*
Submit
Date of Signature
*
-
Month
-
Day
Year
Date
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SIGNATURE EVENT WAIVER
CAMPER
Contact Information
Camper Birthdate
*
-
Month
-
Day
Year
Date
Camper Age
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone
*
-
Area Code
Phone Number
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Camper Health Information
To be completed by Parent or Guardian
Is Camper Covered by Family Health or Medical Insurance?
*
Yes
No
Insurance Carrier, Plan Name or Medishare Name
Name of Insured
*
First Name
Last Name
Relationship to Camper
*
Insurance ID Number
*
Insurance Card
*
Browse Files
Upload copy of both sides of insurance card
Cancel
of
Immunizations up to date?
*
Yes
No
If "No" please explain
Currently Taking Medications?
*
Yes
No
Medications Taking
Dosage
Describe the dosage and frequency of administration
Chronic or Recurring Illness or Medical Condition
Activity Restrictions?
*
Yes
No
Health or Medical Concerns
*
Please describe any other health or medical concerns.
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Emergency Contact 1
*
First Name
Last Name
Emergency Phone 1
*
-
Area Code
Phone Number
Emergency Contact 2
*
First Name
Last Name
Emergency Phone 2
*
-
Area Code
Phone Number
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Permission
Camp activities include strenuous outdoor activities and out of camp travel in camp vehicles. As with most activities there is an inherent risk in participating in these activities. IT IS MANDATORY THAT THIS FORM IS FILLED OUT, SIGNED, DATED, AND RETURNED BY YOU. GUESTS WILL NOT BE PERMITTED TO STAY UNLESS WE HAVE RECEIVED THIS FORM. A copy of this form will be emailed to you upon completion.
Parent/Legal Guardian Name 1
*
First Name
Last Name
Signature 1
*
Parent/Legal Guardian Name 2
*
First Name
Last Name
Signature 2
*
Submit
Should be Empty: