Registration

Child's Name*

First NameLast Name

Child's Current Grade*

Child's Gender*

Does your child have any known allergies?*

If yes, please list any allergens (food or other) here:

Does your child have any special accommodation needs?*

If yes, please describe:

Does your child have any physical restrictions?*

If yes, please describe:

Does your child take any medications?*

If yes, please describe (please be as detailed as possible: time, dosage amount, etc.):

Parent's First Name*

Parent's Last Name*

Parent's Email*

Confirm Parent's Email*

Northridge Church will be sending the Camp Baldwin Liability Release Form via email to the email address given above. In order for the participant to attend camp, this form MUST be completed and returned to us.*

I acknowledge that this form must be completed to attend camp

Parent's Phone*

Parent's Phone

Emergency Contact Name*

Full Name

Emergency Contact Phone*

I grant permission for my child to be photographed/videotaped during Camp, and I authorize Northridge Church to use these photos, videos, and other likeness for any promotional materials before, during, or after Camp. These promotional materials may include posting on social media platforms. Such materials will not be given or sold to other parties and will not include names or identities.*

YesNo

How will you be paying?*

Cost is $50 per camper.

If paying by check, please make out your check to Northridge Church and include Alive Youth Camp Baldwin on the memo line of the check. If paying online, please include Alive Youth Camp Baldwin in the memo line.

NORTHRIDGE CHURCH WAIVER OF LIABILITY AND ASSUMPTION OF RISK

I wish to enroll my child or legal ward in Camp Baldwin Retreat (“activity” or “activities”), an activity of Northridge Church's children’s ministry (the “Church”), in consideration, I, acknowledge and agree that:

1. I am the parent/guardian with legal responsibility for my child/ren registered above (“Child”) and I have given my consent to the Church for my Child to enroll in this activity. I am aware of the physical risks my Child faces due to the active nature of this activity. I understand that the actions of my Child cannot be controlled at all times.

2. I hereby certify that I am at least eighteen (18) years of age and legally competent to sign this waiver on behalf of my Child.

3. I agree that my signing this agreement is entirely voluntary.

4. I understand this agreement is binding not only on me, but also on my respective representative heirs.

5. I hereby certify that my Child is able to enroll in this activity of the Church. I understand it is my obligation to inform the Church of any and all health considerations or medical conditions that would restrict my Child’s involvement in the activities.

6. I personally assume all risk in connection with my enrolling of my Child in the Church’s activities for any harm, injury, or damages that may befall my Child as a result of my enrolling of my Child in the Church’s activities, whether foreseen or unforeseen, and I still wish to enroll my Child in the activities. I hereby voluntarily release and forever discharge and agree to indemnify and hold harmless the Church from any and all liability and responsibility for any loss, damage, or injury of any kind that I or my Child may suffer as a result of or in any way connected with the enrollment in the activity. This release covers any loss, damage or injury caused by: a) Any criminal, illegal or unauthorized acts of third parties; b) Any injury or assault that may occur due to the actions of one of the minors enrolled in the activities; c) Any injury that may occur due to my Child by a volunteer or employees’ during their service for the Church; d) Any conditions, developments, actions or omissions outside of the control of the Church; e) Any other expected or unexpected conditions, developments or risks connected with volunteer service for minors with special needs, even if I or my Child suffer the loss of money, property, health, or life, and irrespective of who is or may be at fault, or whose negligence, including the negligence of the Church, may have caused loss, injury or death.

7. If my Child needs medical attention while attending Church’s activities, I give the Church, its employees and volunteers, permission to seek medical diagnosis and treatment which in their best judgment they deem to be necessary or appropriate under the circumstances. I understand I am financially responsible for all medical and transportation expenses incurred as a result of the use of this consent.

8. I agree that any claim or dispute arising from or related to this agreement, other than a claim for injunctive relief as otherwise provided in this Agreement, shall be settled by mediation or arbitration in Escambia County, Florida. Judgment upon an arbitration award may be entered in any court of competent jurisdiction. I agree that each party, myself and the Church, shall bear our own costs related to any other medical or arbitration proceeding.

9. I have fully informed myself of the contents of this WAIVER OF LIABILITY by reading it before I signed it. PARENT OR GUARDIAN: I agree that we both shall be bound by this Agreement.

I have read the above Activity Release Statement and will sign my name below.*

Please type first and last name

Camp Baldwin Youth Registration