SMCA Summer Camp Program 2024 Waiver Form
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Child's First and Last Name *
Parent or Guardian's First and Last Name *


I, the undersigned, [Name Listed Above], hereby certify that I have legal custody of the minor named above and have given our consent for him/her to attend the 2024 St. Mary's Coptic Orthodox Church of Raleigh, NC Summer Camp Program. I understand that participation in the summer camp program involves inherent risks, and I hereby release St. Mary's Coptic Orthodox Church of Raleigh, NC, its affiliates, related entities, their officers, agents, servants, employees, clergy, and volunteers (collectively, "The Church") from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my child's involvement, whether due to intentional acts or omissions, recklessness, or the negligence of The Church or those of third parties.

I acknowledge and agree on behalf of the minor named above, myself, all heirs, assigns, or successors, that the purpose of the 2024 St. Mary's Coptic Orthodox Church of Raleigh, NC Summer Camp Program is to provide educational and recreational activities within a Christian environment and that I am releasing The Church from any and all liabilities in law or equity, however, the liability may arise, for any injuries, damages, losses, or expenses to myself or my property. I agree and consent that any disputes arising out of the minor's participation in the 2024 Summer Camp Program and all claims that I may bring against The Church, regardless of where the claim occurred, shall be subject to the laws of the State of North Carolina.

I agree that should any damages arise out of the participation in the 2024 Summer Camp Program, I am financially responsible. In the event that the aforementioned minor is injured and requires medical attention, I consent to any reasonable medical treatment as may be deemed necessary by a licensed physician. In the event that treatment is required from a physician and/or hospital personnel chosen by The Church, I agree to hold The Church free and harmless arising from the giving of such consent. I also acknowledge that we will be ultimately responsible for the cost of any and all medical care.

Furthermore, I allow the use of the minor's photograph taken at any activity during the 2024 Summer Camp Program in any promotional material. By typing my full name below, I certify that I have read all provisions of this permission slip, including the Consent and Release, and any additional rules or regulations that may be provided. I bind myself and the aforementioned minor to the terms thereof.

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