SUPER WINTER REGISTRATION 2024

Participant Information

Once you have completed this form, please submit payment for Super Winter to your local church.

First Name *

Last Name *

Church: *

Please select the church you are registering with. For those not registering with a church (Speaker, Band, Cooks and College Staff) select "Not Registered with Church."

School Grade: *

Students, select your school grade.

Gender: *

Address: *

City: *

State *

AR

Zip Code: *

Phone Number: *

Parent's Name: *

Adults use this category to list another emergency contact.

Parent's Phone Number: *

Please include area code.

Emergency Contact's Name: *

Emergency Contact's Phone Number: *

Please include area code.

Emergency Contact's Relation to Student *

Health Insurance Company:

If you don't have health insurance, write "none."

Health Insurance Policy Number:

If you don't have health insurance, write "none."

Primary Care Physician's Name:

If you don't have a physician, write "none."

Primary Care Physician's Phone Number:

Please include area code or write "none" if you do not have one.

Allergies *

If you don't have allergies, write "none."

Focus Sessions

Using Your Platform - Richard Ball

Apologetics - Cody Robinson

Evangelism - Led by John Chronister

How To Study the Bible - Led by Tyler Dixon

Anxiety/Depression - Eric Burton

God, Guys, and Girls - Brad Morgan

First Focus Session Choice *

During Super Winter, you will have the opportunity to attend four different focus sessions, during which we will study what the Bible has to say about different topics. Please choose one of the options below. Those registering as staff select "staff" for all four sessions. *Adult leaders select a session unless you are pastors/band/speaker/cooks*

Second Focus Session Choice *

During Super Winter, you will have the opportunity to attend four different focus sessions, during which we will study what the Bible has to say about different topics. Please choose one of the options below. Those registering as staff select "staff" for all four sessions. *Adult leaders select a session unless you are pastors/band/speaker/cooks*

Third Focus Session Choice *

During Super Winter, you will have the opportunity to attend four different focus sessions, during which we will study what the Bible has to say about different topics. Please choose one of the options below. Those registering as staff select "staff" for all four sessions. *Adult leaders select a session unless you are pastors/band/speaker/cooks*

Fourth Focus Session Choice *

During Super Winter, you will have the opportunity to attend four different focus sessions, during which we will study what the Bible has to say about different topics. Please choose one of the options below. Those registering as staff select "staff" for all four sessions. *Adult leaders select a session unless you are pastors/band/speaker/cooks*

RELEASE

I hereby consent to participation by my child in Super Winter 2024. I fully understand that this event will take place away from the church grounds and that my child will be under the supervision of the designated staff and/or volunteers of Spring Lake Camp and the participating churches. I understand that such an undertaking involves an element of risk. I assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify, and agree to hold harmless Spring Lake Camp, and the participating churches, and all associated agents from any and all liability that may arise out of participation in this activity. I give consent for emergency medical treatment if necessary, as determined by the trip chaperones from the church my child attends with. I agree to hold harmless and release Spring Lake Camp and the participating churches and their agents from any and all liability related to expenses arising from the giving of such medical care. As parent/legal guardian, I remain fully liable for any legal responsibility which may result from any personal actions taken by the named participant. I hereby grant permission to Spring Lake Camp and the participating churches to use my child’s likeness on its promotional materials including, but not limited to videos, websites, and printed materials without further consideration, and I consent to the right of Spring Lake Camp and the participating churches to crop or treat the likeness at their discretion. *

In the case of an adult registering himself or herself to attend, checking the box below indicates agreement with the above conditions understanding the same conditions and risk apply to him or her that would a minor being registered by a parent.

By checking this box, I acknowledge that I am the parent and/or legal guardian of the minor listed above. Furthermore, I consent to the stated conditions.

Required

Name of Parent or Legal Guardian Giving Consent to Participate: *

In the case of an adult registering himself or herself, type your name as the one consenting to your own participation.