Love Out Loud Student Camp Registration

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Love Out Loud Student Camp 2021 - Student Form

Student Name *

Address *

Phone *

Birthdate *

YYYY

Gender *

Female

Male

2020/2021 School grade *

Parent's email *

Student's email

Middle School & High School will have different work sites. Which age group is your student in? *

LOVE OUT LOUD STUDENT CAMP MIDDLE SCHOOL STUDENT $175

LOVE OUT LOUD STUDENT CAMP HIGH SCHOOL STUDENT $175

LOVE OUT LOUD STUDENT CAMP MIDDLE SCHOOL STUDENT - DAY CAMP ONLY $125

LOVE OUT LOUD STUDENT CAMP HIGH SCHOOL STUDENT - DAY CAMP ONLY $125

T-Shirt Size (Choose one- Adult sizes)

XXL

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Church Affiliation (if any)

Emergency Contact Name & Relationship to Student *

Emergency Contact Phone #

Emergency Contact Name & Relationship to Student

Emergency Contact Phone #

Family Physician- Phone # *

Insurance Provider

Policy # or Group #

Please list any medical allergies, medications being taken, medical problems, or other pertinent information:

Please list any special dietary needs:

Special arrangements:

Student will need to leave camp early. Please note that for the safety of students all early pickups and returns will only occur during morning devotional and evening worship and student will only be released to the name on record.

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READ THIS FORM COMPLETELY AND CAREFULLY. YOUR CHILD'S PHOTOGRAPH MAY BE USED IN FUTURE LOVE OUT LOUD PUBLICATIONS. I UNDERSTAND THAT IN THE EVENT MEDICAL TREATMENT IS REQUIRED FOR MY CHILD, EVERY EFFORT WILL BE MADE TO CONTACT ME. HOWEVER, IF I CANNOT BE REACHED, I GIVE MY PERMISSION TO THE STAFF OR SPONSOR TO SECURE THE SERVICES OF A LICENSED PHYSICIAN AND/OR OTHER NECESSARY HEALTH CARE PROVIDER TO PROVIDE THE CARE NECESSARY, INCLUDING ANESTHESIA, FOR MY CHILD'S WELL-BEING . YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIAL DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF LOVE OUT LOUD STUDENT CAMP USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE INJURED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY. BY ELECTRONICALLY SIGNING THIS FORM, YOU ARE GIVING UP YOUR CHILD'S (YOUR) RIGHT TO RECOVER FROM LOVE OUT LOUD STUDENT CAMP, OR VOLUNTEERS, OR STAFF THEREOF, IN A LAWSUIT FOR ANY PERSONAL INJURY TO YOUR CHILD ,OR ANY PROPERTY DAMAGE RESULTING FORM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM AND LOVE OUT LOUD HAS THE RIGHT TO REFUSE TO LET YOUR CHIILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM. *

BY CHECKING THIS BOX, I AGREE THAT I AM 18 YEARS OF AGE OR OVER AND I HAVE READ THIS FORM COMPLETELY AND AGREE TO THE ABOVE TERMS.

I DO NOT AGREE TO THE ABOVE TERMS AND UNDERSTAND LOVE OUT LOUD HAS THE RIGHT TO REFUSE MY CHILD'S (MY) PARTICIPATION.

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