Participation Form
Christos Community Church | Camp Leonardo
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Email *
Camp to which you are registering them
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Parent / Guardian's name *
Parent / Guardian's phone *
Emergency Contact - Name & Phone
If different than Parent / Guardian
If any of your children attending Camp have a medical condition, provide his / her name and an explanation of such condition.
In case of emergency, do you want the camp director to seek medical care for your child / children attending camp? *
If yes, provide name of physician / medical center you would like the camp director to contact first.
If any of your children attending Camp has a disability, provide his / her name, a description of the disability, and suggestions on how we could serve him / her better.
Do you authorize the use of pictures / video of the above-named participant(s) to be posted on Camp Leonardo web site or advertising media published by Christos Community Church. *
LIABILITY WAIVER: I am aware that participation in Camp Leonardo has some inherent risks and injury can occur, including exposure to Covid-19. On rare occasions these injuries can be serious. In consideration of my child / children being allowed to participate in Camp Leonardo, I, the parent/guardian, assume the risk of all injury and agree not to sue Christos Community Church, the camp directors, teachers, assistant teachers, agents, or volunteers for any and all injuries caused by or resulting from participating in Camp Leonardo. *
Sign by providing your name and today's date.
A copy of your responses will be emailed to the address you provided.
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