2023 Pilgrim Home Baptist Church Extreme Camp Registration
When: Monday, June 26 - Thursday, June 29
Where: Pilgrim Home Baptist Church
Time: 10am-1:30pm
Ages: Completed Kindergarten - 6th Grade
Cost is Free! Snacks and Lunch are Provided!
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Parent/Guardian Name(s) *
Home Address *
Primary Phone Number *
Secondary Phone Number *
Student's First Name *
Student's Last Name *
Student's Most Recently Completed Grade *
Special Attention Needs: Please provide any Special Attention Needs (including, but not limited to: Hearing/Sight Impairment, Allergies, and Wheel Chair Accessibility) that your child may have. DO NOT disclose any confidential information: *
WAIVER AND RELEASE
CAUTION: Read this document carefully before signing. This is a general release and indemnification of claims.
Consideration
I acknowledge the personal benefits accruing to me (and my child, as applicable) by reason of participation in the above described event and am aware of the activities in which I, or my child, will be involved through said participation.
Release/Indemnification
I hereby, in consideration of such benefits and other good and valuable consideration received, consent to the above listed participation and release absolutely, forever discharge, hold harmless and covenant not to sue Wired Ministries, Inc. and the Extreme Kids Camp location (including schools, churches, business, and conference centers), its directors, employees, agents, volunteers and from any and all present or future liability, claims, demands, actions or rights of action, whether asserted by me or a third party arising out of my (or my child’s) participation in event activities (the “Claims”). I agree to indemnify and hold harmless Wired Ministries, Inc. and camp location for any such Claims brought by me or a third party from any costs associated with defending or litigating such claims, including but not limited to attorney fees, costs and legal expenses.
Medical Emergency
In the event of injury or a medical emergency, I understand that the camp or event director, church official, any camp or event staffer, or adult present or in charge of first aid will to obtain necessary medical attention in case of sickness or injury for all attendees. If a camper requires medical attention while at camp, the camper or their parent/guardian is responsible for the cost. It will be the church group leader’s responsibility to assess medical needs, obtain and consent to appropriate medical care, transport persons in need of medical care and contact parents or guardians of minors. I release Wired Ministries, Inc. and camp location from any and all liability related to medical treatment. In addition, I assume the risk and financial responsibility for any injury resulting from the attendee’s participation in all Wired Ministries, Inc. and camp location events.
Recreation Addendum
The recreation programs at summer event locations strive to offer fun, safe and challenging activities that engage the whole person--body, mind and soul. Program staffs are trained and as a team committed to your rewarding experience with safety as their highest priority. However, there are inherent risks to participation in recreation activities, including but not limited to, initiative games, high and low challenge course, outdoor education, and sports. You could experience any of the following - elevated heart and respiratory rates, uncomfortable group dynamics, climbing or descending unpredictable and possibly slick or uneven terrain, jumping, running, climbing, traveling long distances in remote settings, carrying weight on your backs and shoulders, unforeseen forces of nature or weather, any of which could result in injury/illness that could result in loss of life, limb and/or property.
Assumption of Risk
I am aware of the risks associated with participation in any camp related event and do hereby voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including death, that may result from participation in event activities.
Understanding
I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein, and I signed voluntarily as my free act and deed that I have had an ample opportunity to obtain the advice of counsel and that, by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be construed as broadly and inclusively as is permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect.
Media Consent
I give my consent and permission for the taking of photographs and/or video of me (or my child) during the described event and waive and/or assign any and all rights (including copyright) in such media to Wired Ministries, Inc. and camp location. Wired Ministries, Inc. and camp location, as the sole owners of such media, shall have the exclusive right to control and determine the use, display, performance, reproduction and dissemination of any such photographs and/or videos.
Copy to Camp Location
It is understood and agreed that a copy of this form shall be treated as authentic and binding as the original and that a copy of same shall be provided to your camp location.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS AGREEMENT INCLUDES A WAIVER OF LIABILITY AND RELEASE AND AN AGREEMENT BY ME TO INDEMNIFY AKK PARTIES AND I SIGN IT OF MY OWN FREE WILL. *
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Parent/Guardian Digital Signature: Please type out your full name. *
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