Prodigal Kids Camp Registration
Event Dates: JULY 8-11th 2024      9am-12
Event Address: 5445 N. Palm Ave. Fresno CA 93704 (Cross Streets Palm & Browning)
Contact us at (559) 789-4200 or prodigalchurchfresno@gmail.com
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Childs Name (One form per child please) *
Grade Completed *
Date of Birth & Age *
Parents Name *
Parent Cell ( and alternate Ph. #) *
Emergency Contact  & Ph # and relationship to student *
Food Allergies or Medical Concerns *
Required
Medical Doctor & Ph # *
Name of persons who may pick up your child *
Liability Release Form                                                                      I (the undersigned) for the student indicated below, apply to Prodigal Church to participate in the activity described and indicated above ("Activity"). I acknowledge and agree to, and represent, the following for myself and the student, in consideration of the opportunity to be provided by the Church (contingent upon its agreement to my child's and/or my participation).Acknowledgment of Risks. I acknowledge that participating in the Activity involves risks of serious damage and harm to persons and property, and even death, and I assume those risks, including risks arising from acts or failures to act of the Church.Information Relied on by Church. I am the parent or legal guardian for the student for whom this document is signed. The student is in good health and sound mind. If necessary, I have discussed or will discuss with my physician the student's participation in the Activity, and the student has received or will receive any vaccination or other recommend prerequisite medical treatment my physician deems necessary. The student will participate in the Activity only if I have received my physician's approval, if I deem it necessary, and believe that the student is able to participate without harm. I acknowledge that the Church will not assess or approve the student's fitness for participation. I am under no force or duress of any kind to compel the student's participation in the Activity or my signing of this document.Release. THIS DOCUMENT IS INTENDED TO ABSOLVE THE CHURCH OF ANY LIABILITY TO ME OR THE STUDENT THAT IS RELATED TO THE STUDENT'S PARTICIPATION IN THE ACTIVITY. Accordingly, I hereby release the Church from, waive, and will never sue the Church for, any damage (whether damage to or loss of property, finances, life, body, mind, or emotions), cost, suit, demand, claim, or other liability, that arises or is alleged to arise from or in connection with the student's participation in the Activity. Such liability includes any liability that arises or is alleged to arise from the Church's negligence (but not its willful and wanton misconduct). Such liability also includes any liability that arises or is alleged to arise from claims for contribution by another that the student or I have sued or from whom the student or I have received compensation.Medical Permission. I give my permission for the student to be treated for illness or injury sustained while participating in the Activity, including by the administration of emergency anesthesia or surgery; and authorize the adult leaders of the Activity to act on my behalf in ordering such treatment.Definitions. (a) References to "me," "my," and "I" shall include and bind the student, my spouse, any parent of the student for whom this document is signed, any guardian or other person with responsibility for the care and supervision of such student, and any insurer, heir, estate, legal representative, executor, administrator, successor, or assign of me or such student. (b) "Participation" or "participating" in the activity includes planning and preparing for, traveling to, and traveling from, as well as participating in, the Activity. (c) The "Church" includes (i) its affiliates, and institutions cooperating in the Activity; (ii) the trustees, elders, deacons, officers, employees, volunteers, and agents of the Church or such affiliate or institution; and (iii) the spouses, insurers, heirs, estates, legal representatives, executors, administrators, successors, estates, and assigns of any of the fore going.PARENT/GUARDIAN. By selecting yes below and submitting this registration form I agree to the above terms. *
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