13th Annual ICH Youth Camp Application
If payment is not made then the application will not be processed
First come first serve(you will be put on a waitlist if we reach capacity)
(you will not be turned away if you cannot afford the trip, Contact the Brother down below)

Omar Khalil: (310) 991-9178
ichyouth@gmail.com
REGISTRATION MAY CLOSE AT ANY TIME DEPENDING ON AVAILABILITY
Parent/Guardian Consent and Liability Waiver
I, the undersigned, being the parent of the named person(s) below or youth member over 18 years old, do hereby give my consent and approval for my child’s
(myself) participation in the following recreational activity: ICH YOUTH CAMP. I hereby assume all of the risks and hazards incidental to the conduct of said
activity insofar as it relates to my child. I hereby release employees and the activity leaders, including instructors, assistants and volunteers and any or all of
them from any damage and/or liability arising out of or in connection with the participation of my child in said activity. In the event of injury to my child, I
assume responsibility therefore, and hereby waive any and all claims for damages for my child.
Parent/Guardian Statement
I have read the Parent/Guardian Consent and Liability Waiver (Above), and discussed the camp
rules on the back of this form with my child(ren) and promise to pick
up my child(ren) from the camp if I am asked to do so.
Parent initial *
Your answer
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