Spark Session 2022 Camper Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

June 26th - July 1st @ Camp Rock Creek / Students going into 4th Grade - Graduated High School Seniors

Email *

Student's Name *

Student's Age *

Student's Grade (the grade they will enter into next school year) *

Emergency Contact - Name, Number, and Email *

What Church Do You Attend? *

Are you a baptized Christian? *

Yes

If not baptized, do you permit your child to be baptized at camp if they desire to do so? *

Yes

Call Me First

Required

Shirt Size? *

Youth M

Youth L

Adult XS

Adult S

Adult M

Adult L

Adult XL

Adult XXL

Adult XXXL

Does Student take daily meds? If yes, list all medications and instructions (For our Nurse) *

Is participant covered by personal/family medical insurance? *

Yes

If yes, Please add Insurance Company, Policy Number, Policy holder's name, and date of birth *

Is sponsor (Southwest) authorized to approve medical treatment? *

Yes

Call First

Other:

Required

Dietary restrictions *

None

Vegetarian

Vegan

Kosher

Gluten-free

Other:

How will you be paying? *

PayPal (link on Sparksession.org/register)

Check upon arrival

Cash upon arrival

Required

Insurance Disclaimer:

By submitting this form, the participant (or parent/guardian) acknowledges and accepts the risks of physical injury associated with participation in the activity described above, except for gross negligence on the part of the sponsor. The participant (or parent/guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (or parent/guardian) promises to hold harmless the sponsoring organization and its representatives for any injury related to the activity. I relieve Camp Rock Creek and the Southwest Church of Christ from any liabilities due to sickness, accidents, and/or injuries while attending the camp or while coming to or from the camp grounds. If I cannot be reached by phone, I give my consent to the director or nurse to authorize physicians to administer medical help.

I understand and accept that I release Southwest church of Christ and Camp Rock Creek from any accident or incident that occurs to my child during Spark Session. *

Yes

Required

COVID-19 Disclaimer

By submitting this form, the participant (or parent/guardian) acknowledges and accepts the risks of possible exposure to COVID-19 associated with participation in the retreat. We will do everything we can to keep this a fun and safe environment. however with the unknowns of this virus, your student may contract it at any point. The participant (or parent/guardian) accepts personal financial responsibility for any testing or quarantine responsibilities if student contracts the virus. Further, the participant (or parent/guardian) promises to hold harmless the sponsoring organization (Southwest church of Christ) and its representatives for any sickness related to the retreat.

I understand and accept that I release Southwest church of Christ and Camp Rock Creek from any illness or exposure to COVID-19 or any other illness during Spark Session. *

Yes

Required

Social Media and Photo Release Form

This form authorizes Southwest church of Christ (Spark Session) and Camp Rock Creek to publish photos and videos taken of minors who attend the camp session. I am aware that this form releases the Southwest church of Christ from any liabilities or claims. These photos and videos could be published on Facebook, Instagram, YouTube, and the church's website for advertisement and promotional purposes.

I understand and accept that I permit Southwest church of Christ and Camp Rock Creek to publish photos and or videos of my child taken during Spark Session. *

Yes

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms