Camp Alive 2018 Registration Form

Please complete the form below to be registered for
Camp Alive 2017
Camp Attendee Last & First Name (e.g. Smith, John) *
Your answer
Attendee's Grade or Position for 2018-2019 year *
What Church Do You Attend?
Gender *
Attendee's Adult T-Shirt Size *
CONTACT INFORMATION
Parent's Name *
Your answer
Parent's Email *
Your answer
Parent Primary Contact Phone Number *
Your answer
Student/Staff Contact Number *
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
MEDICAL INFORMATION AND CONSENT
Please list any medical conditions the Registrant has, and any other medical details including any prescriptions that we need to be aware of (Write Not Applicable if this doesn't apply): *
Your answer
Does your child have any medically necessary dietary restrictions (Please list if applicable): *
Your answer
By typing my full name below, I hereby acknowledge I am 18 or older and authorize the participation of the above-named Registrant in activities with Camp Alive 2017. In consideration of Believers Fellowship involved providing these activities. I, on behalf of myself and the other parents and guardians of the minor, do hereby release all participating churches, their agents, pastors and members of their Board of Elders from all claims and causes of action by reason of any injury which may be sustained as a result of these church activities, whether on or off the church premises or on the way to or from these activities. I hereby give my permission to the physician, nurse, or dentist selected by participating churches to secure medical or dental aid as required for illness or injury under a physician’s orders, including transportation to and from the necessary facilities. As a participant, I understand the participating churches are not obligated to carry any insurance to cover those medical and/ or dental expenses. If such insurance is carried, coverage will be provided only for expenses in excess of the limits of the participant’s insurance. I understand that my personal insurance is my primary coverage. Please type your name below to agree to the above statement and to indicate that you are giving your child permission to participate in Camp Alive 2017 hosted by Believers Fellowship. *
Your answer
Payment Information:
If you do not attend Believers Fellowship, please contact your church's youth leader to find out payment details and deadlines.If you are attending with Believers Fellowship please pay the $50 deposit that is due at the time of sign up. (Please indicate "Camp Alive, student's name & whether they are in high school or middle school" on the memo line of any checks and give the checks directly to one of the high school or middle school leaders).
Additional Information (optional):
Your answer
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