2022 High School Camp Registration
hosted by Circleville & Soldier Christian Churches
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First Name *
Last Name *
Grade Level as of Fall 2022. *
Tshirt Size? *
Who should we contact in case of an Emergency? *
What is your emergency contact's phone number? *
Do you have any allergies, illnesses or specific medical instructions that would be helpful for us to know about? (optional, and any comments entered here will be followed up on by an adult before we leave.)
The current schedule has us leaving Monday Morning at 9am from Circleville Christian and returning Friday by 3pm to Circleville Christian. (Travel time one way: 2 hours hours)  Do you need to arrive late, leave early or be gone at any point for any reason? (A club sport, family obligation, etc.) If so when will you need to be gone? *
Please read the paragraph below:
I understand that my child will be participating in CCC & SCC's Sr. High Camp event, outings and activities. I recognize that my child will have the opportunity to take part in all activities and travel with the churches, and grant my permission for my child to be included in these activities and trips. I do not hold the church, church leaders, or church participants liable for unforeseen accidents to my child. In the event of any and all potential issues including but not limited to accident, sudden illness, or medical emergency involving my child, I hereby authorize the staff member and volunteers of said churches as adult persons into whose care the minor has been entrusted, to use their best judgment in the matter and hereby do consent to release my child into their care for the authorization of any medical treatment and/or hospital care as deemed necessary by a licensed physician.

Additionally, I give full permission for my child to ride in vehicles, including but not limited to personal vehicles and church bus/van, driven by authorized leaders, staff, and affiliates while on this trip.

I am the student's guardian and consent to the above statement *
Lastly, could we have an email to send the Waiver/Permission Slip to you? *
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