Name of applicant

Pronunciation for Kanji name

Sex

Address : including apartment No.

Phone type

Phone No.

確認のためもう一度

Contact for emergency (name/ Phone No./ address)

宿泊タイプをご確認ください。Please check type of accommodation.  一泊参加申込につきましては7月25日までに受理可否を連絡いたします。それまで保留とさせて頂きます。 For one overnight applications, we will inform you of acceptance or rejection by 7/25.It will be on hold until then.　

Additional meals if needed for one night stay camper(s). $10 per meal. 

受付確認メールで詳細ご案内します。Detailed information will be included in your registration confirmation email.

Arrival date and time

Meal - - if you want veggie, let us know it.  In case of vegan, please inform us separately.

Meal - - if you have food allergies, let us know it.  

Accompanied family name (Spouse)

Sex

Accompanied family name (child)

Sex

Age as of 8/1 and grade in the next school year

Accompanied family name (child)

Sex

Age as of 8/1 and grade in the next school year

Accompanied family name (child)

Sex

Age as of 8/1 and grade in the next school year

accompanied family name (child)

Sex

Age as of 8/1 and grade in the next school year

（１）賛美チーム参加ご希望の方はボーカル含む演奏可能な楽器を記入ください。For those who would like to join the worship team, please list  the instruments you can play, including vocal. 

私、または私が法的責任を負う私の子供、被扶養家族は、このキャンプに自己の向上やﾘｸﾘｴｰｼｮﾝの目的で、自分の意志から参加することを理解、同意します。私は、参加に伴うあらゆる危険を想定していることを表明するとともに、私、私の子供、被扶養家族に起こりうるあらゆる損害に関し、ミシガン・バイブル・キャンプに対し、私、私の子供、被扶養家族が持つあらゆるまた全ての要求、法的措置、訴訟、訴訟手続きを放棄また譲渡します。私は、そのような損害から生ずるあらゆる医療費やその他の費用について自己負担するということを理解、同意します。万一の医療的な緊急事態には、ミシガン・バイブル・キャンプ準備会またボランティアに取るべき医療措置を委ねます。私(18歳以上)は、この文章全体を注意深く読み、理解し、申込書に自分の意志で同意します。私は、上記の文言すべてを理解、同意し、私の子供、被扶養家族の参加についても承認します。 ■ 保護者の方へ ：上記申込者の親権者、保護者である私は、上記申込者の修養会への参加を、自分の意志により承認します。私は、自分の意志によって申込書に署名することにより、そのことを保証します。＊当日受付時に提出して頂きます。  ACKNOWLEDGMENT AND RELEASE OF LIABILITYI understand and agree that my participation or the participation of my child or dependent, for whom I am legally responsible, in such activities is a voluntary activity entered into for the purpose of personal development and recreation. I expressly assume all risks of participating in the event. I hereby waive and release any and all claims, actions, lawsuits and proceedings that I or my child or dependent might have against Michigan Bible Camp arising out of any injury that I or my child or dependent might sustain. I understand and agree that I am solely responsible for any medical expenses and other costs and expenses arising out of such injuries. In the event of an apparent medical emergency, I authorize Michigan Bible Camp personnel or volunteers to obtain medical emergency help. I have carefully read this release in its entirety, understand it, and sign it on the registration form voluntarily, and am over 18 years of age. I understand and agree to the above provisions and hereby authorize the participation of my child or dependent in the described event.FOR THE PARENT OR GUARDIANI, the parent or guardian of the above named Participant, give my voluntary consent to his or her participation in such activities. I certify this by signing it voluntarily on this form.