Captain's Camp 2018
March 23 - March 24, 201
REGISTRATION FEE: $45

An interview with church leadership will be required the week of March 4 -10 in order to qualify for a spot.
Sign-up for interviews will be available during theBranch youth group.

Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Phone Number *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email *
Your answer
Student Grade
2017-2018 School Year
Your answer
Previous BYBC Participation *
2016-2017 School Year
Health Insurance Company *
Your answer
Name of Insured *
Your answer
Policy Number *
Your answer
The undersigned does hereby give permission for our Child to attend and participate in Captain's Camp 2018 sponsored by Wells Branch Community Church on March 23 - March 24, 2018. We (I), being 21 years of age or older, do for ourselves (myself) and for and on behalf of my child-participant (if said child is not 21 years of age or older), do hereby release, forever discharge and agree to hold harmless Wells Branch Community Church and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participating in the above-described trip or activity. Furthermore, we (I) and on behalf of our (my) child-participant of under the age of 21 years, hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation. Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant. We (I) also agree to pay the full amount of $45 before the date of the event. I understand that 50% of what is paid towards the balance of the retreat is considered to be a non-refundable deposit securing my child’s place on the retreat. The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees and agents, for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto. We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs. *
Parents/Guardians, please type your full name and the date as your electronic signature acknowledging that you have read and agree with the release above.
Your answer
Please make checks out to Wells Branch Community Church with "Captain's Camp 2018" in the memo line
(We encourage our students to write support letters asking their community to partner with them in the ministry of taking the life-changing reality of Jesus Christ into our community. If you do need additional financial assistance, please contact Joseph Aiken at Joseph@wellsbranchchurch.com)
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms