Camp Moed 2022 Forms - Grace Immanuel Bible Church

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Camp Moed 2022

Email *

LName (of person attending): *

Address, City, Zip: *

Phone: *

Emergency Contact (name/relation & phone number) *

I/We (Parent/Guardian) _______ hereby consent for my child (named above) to participate in Camp Moed 2022 on June 16-19, 2022, and I certify that my child is able to participate in all activities that may be included in this event. (insert name below) *

If my child has medical conditions, which may be relevant to a physician in the event of any emergency, I have listed them on the provided medical form. In the event of an emergency occurring, I may be reached by the emergency contact number listed above and on the medical form. If I cannot be reached, I hereby authorize Grace Immanuel Bible Church leaders (Charla Macchiavello, Josh Macchiavello,) or pastor (Pastor Clark Sexton) to make emergency decisions for my child. (insert name) *

I understand and hereby agree to assume all of the risks, which may be encountered with this activity, including activities preliminary and subsequent thereto. I do hereby agree to hold Grace Immanuel Bible Church, and its agents and employees, harmless from any and all liability, actions, cause of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which may arise in the future, connected with the activity or participation in any other associated activities. (insert name) *

I, furthermore, do not hold Grace Immanuel Bible Church, in any way, responsible for the loss of any personal property via theft, accidental loss damage, left behind, destroyed, from any youth event. And do not expect any loss replacement or money to replace any items that were lost, stolen, or destroyed from any youth event hosted by GIBC. (insert name) *

I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement, which I have read and understand. (attendee name - 18+, or parent/guardian name if under 18) *

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