Backyard Bible Camp Registration And Medical Release

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Age group: Kindergarten - Age 12 Date: August 18th - 21st 2020 Time: 2-3 PM Location: Fort St John area

Email *

Camper's Name *

Birthday *

YYYY

Age *

Gender *

Female

Male

Prefer not to say

Other:

Mother's name and contact information (phone & e mail) *

Father's name and contact information (phone & e mail) *

Home address *

Names of all people with permission to pick up child from Backyard Bible Camp: *

Emergency Contact Information (Name, phone #, and relation to child) *

Child's MSP Number *

Physician's Name and Number *

List your child's recent injuries, chronic conditions, or anything they take medication for: *

Does your child have any allergies? *

My child does have known allergies

My child has no known allergies

If your child does have any allergies, please list any food, environmental, or drug allergies. *

Please list and explain any other relevant medical information that was not addressed above. Please include activities to be restricted. *

Photography and Publicity Release *

I give permission to all sponsoring organizations to use my child’s likeness, image, voice and/or appearance as such may be embodied in any media including but not limited to pictures, photos, video recordings, audio tapes, digital images.

I do not give permission to all sponsoring organizations to use my child’s likeness, image, voice and/or appearance as such may be embodied in any media including but not limited to pictures, photos, video recordings, audio tapes, digital images.

Charlie Lake Community Church Backyard Bible Camps are Covid-19 Compliant, which means we have set in place: physical distancing, frequent cleaning & sanitizing, limited class sizes, parent outside drop off/pick up only, and frequent hand washing. Parents will be asked each day, if their child is symptom free & that their child has not been given acetaminophen or ibuprofen in the last 12 hours. If a child shows signs of illness during the event, parents may be asked to pick-up their child at the leader's discretion. *

I have read and agree to comply with the Backyard Bible Camp Covid-19 Guidelines set in place by Charlie Lake Community Church.

As legal guardian, I realize no activity is without the possibility of unforeseen hazards, which could result in injury or worse. As a parent or guardian, I am aware of my responsibility to instruct my child/ward of the importance of conduct, which will insure safety for all participants and in doing so I assume full responsibility for my child/ward. I further agree to absolve and hold harmless the sponsoring organizations and their representatives for damage, loss, abuse, death or injuries to my child/ward. By clicking "I agree..." on this form, I give my child permission to participate in this activity, and give my permission to the leaders of this function to authorize any treatment necessary for any injury. I also certify that I am the legal guardian of this child and can sign for them in a legal capacity. *

I agree to the terms and conditions outlined in the above statement

I disagree to the terms and conditions outlined in the above statement

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