GV Kids: Summer Camp 2018
GV Kids (Completed 2nd-5th Grade)

June 7-10 @ Lakeview Camp & Retreat Center, 5128 FM 66, Waxahachie, TX

Cost $290

Student's First & Last Name *
Your answer
Student's Age *
Your answer
Student's Current Grade *
Your answer
Parent's/Guardian's First & Last Name *
Your answer
Parent's/Guardian's Cell Phone *
For emergency purposes
Your answer
Parent's/Guardian's Email *
For communication purposes
Your answer
Does your student have any medical conditions we should be aware of? *
If yes, please explain
Your answer
Does the student have medical insurance? *
GRACEVIEW Liability Release & Permission Form
Release of All Claims

Please sign electronically once you've read the following paragraph

*
In consideration for being accepted by GRACEVIEW Baptist Church for participation in GV Kids Activities. I do hereby release, forever discharge and agree to hold harmless GRACEVIEW Baptist Church and the directors thereof from any 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 activity. Furthermore, I (on behalf of our (my) child-participant if under the age of 21 years) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food and lodging for this participant. The undersigned further hereby agrees 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 activities, 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 cost.
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