LVL UP! Ignite 2018
Email address *
First Name: *
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Last Name: *
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Age: *
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Date of Birth *
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Grade: *
Gender *
Attending Ignite As: *
Church: *
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Home Address: *
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Name of Parent: *
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Parent Phone Number: *
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Parent Email: *
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Second Emergency Contact: *
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Second Emergency Contact Number: *
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What is the student's medical company and policy number? *
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Please List any known allergies your student has: *
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Please share any current medical conditions we should be aware of: *
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Please indicate any medications your student is currently taking *
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Release of Liability Agreement
As a parent / guardian of the camper listed on this form I give permission for him / her to be involved in the overall activities of this event. I also acknowledge that if he/she has to return home early for discipline violations, it will be at my expense. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I understand all reasonable safety precautions will be taken by the staff of this event during the event and activities. I authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of this release in case of an emergency. I agree not to hold the staff or volunteers of Turning Point Open Bible, Intersection Church, Center Church, Country Church of the Open Bible, liable for damages, losses, diseases, or injuries incurred by the subject of this form.
Please write your name for agreement: *
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Signature Date: *
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