Summer Camp Detailed Registration Form

Youth's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is your child prescribed an inhaler? If yes, please explain any instructions.

PHOTO, VIDEO, AND MEDIA RELEASEI grant permission for the Organization to photograph, video record, or otherwise capture my child’s likeness during the event and to use such media for promotional, educational, or ministry-related purposes without compensation.

Yes, I grant permissionNo, I do not grant permission

CODE OF CONDUCT ACKNOWLEDGMENT

I understand that participants are expected to conduct themselves in a respectful and appropriate manner. The Organization reserves the right to remove any participant whose behavior is deemed unsafe or disruptive, and I agree to arrange prompt pickup if necessary.

Informed Consent and Acknowledgement

I, the undersigned parent or legal guardian, acknowledge that I have voluntarily permitted my child/ward (“Participant”) to attend and participate in the above-referenced event. I understand that participation may include, but is not limited to, worship services, teaching sessions, creative performances, group activities, movement, and fellowship with other youth.

I understand that while the Organization will take reasonable steps to provide a safe environment, participation in any group event involves inherent risks, including but not limited to personal injury, illness, emotional distress, or property loss.

I hereby acknowledge that I have been fully informed of these risks and voluntarily consent to my child’s participation.

RELEASE AND WAIVER OF LIABILITY

In consideration of my child being allowed to participate, I hereby release, waive, discharge, and hold harmless the Organization, its founders, directors, officers, employees, volunteers, partner churches, sponsors, and representatives from any and all claims, demands, causes of action, or liabilities, whether known or unknown, arising out of or related to participation in this event.

This release includes, but is not limited to, claims for:

Personal injury
Illness or medical conditions
Emotional or psychological distress
Loss or damage to personal property
I understand and agree that this release applies to the fullest extent permitted by law.

Medical Release and Authorization

MEDICAL AUTHORIZATION
In the event of a medical emergency, I authorize the Organization and its representatives to obtain emergency medical treatment for my child if I cannot be reached. I understand that I am financially responsible for any medical care provided.

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

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 of the named minor child, in my absence.

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

Hey God 2026

Youth Information

CODE OF CONDUCT ACKNOWLEDGMENT