2020 Camp Connexion Youth/Worker Registration
Camp is June 1-4, 2020.
What is your name? *
Your answer
Please choose one: *
What shirt size will you need? T-shirts are $10. *
What church do you attend? *
What is your birthday? (mo/day/yr) *
Your answer
What is your email? *
Your answer
What is your address? *
Your answer
Please list your Insurance Information with Group and Policy Number. *
Your answer
IF YOUTH: Please list Parent Names with Phone Numbers
Your answer
Please list any other contact names with relationship and phone numbers if there is an emergency. *
Your answer
Please list any allergies you have. *
Your answer
Please explain any special needs or any medical issues the camp staff/nurse should be made aware of.
Your answer
I agree that photographs or videos may be taken of me and used in promotional materials. *
Required
I grant my permission for the Camp Director, Assistant Director, or other staff person in charge to obtain necessary medical treatment in case of sickness or injury to the camper named above. I do hereby release and forever discharge all sponsors, Middle Florida Baptist Assembly, Inc. (Camp Pickett Lake), and Camp Connexion from any and all claims, demands, actions or cause of action, past, present, or future, arising out of any damage or injury while employed or participating in Camp Connexion during May 31-June 4, 2020. I hereby also agree to assume obligation for any necessary expense not covered by Middle Florida Baptist Assembly, Inc. insurance policy for the camper named above. *
Submit
Never submit passwords through Google Forms.
This form was created inside of Lafayette School District. Report Abuse