Falls Creek 2018 REGISTRATION
Participant Last Name, First Name
Address, City, State, Zip
Phone (including area code) AND Email address
ADULT T-SHIRT (Women's Cut)
PARENT / GUARDIAN INFORMATION
Parent / Guardian Name
Address, City, State, Zip (if different from above)
Daytime Phone / Evening Phone / Cell Phone AND Email address
Insurance Company and Policy Number
EMERGENCY CONTACT INFORMATION (if parent/guardian cannot be reached)
Emergency Contact Last Name, First Name
Emergency Contact's Phone Number, including area code
COST OF PARTICIPATION:
Total cost is $550.
Deposit (Add $100.00)
Deposit (Add $400.00)
Total Amount before November 30th (Add $500.00)
Total amount after November 30th (Add $550.00)
MEDICAL RELEASE & ACTIVITY WAIVER
In the event of an emergency, I hereby give permission to the church-appointed sponsors who are with my child at the event named below to obtain medical assistance for my child.
I also give permission to the physician selected to hospitalize and secure proper treatment for my child:
Sponsor: CENTRAL VALLEY BAPTIST CHURCH 600 N. Ten Mile Rd., Meridian, ID 83642
Activity: FALLS CREEK CAMP TRIP to Falls Creek, Oklahoma July 14-21, 2018
In consideration of the permission granted to the participant named above, by the above names SPONSOR/CHURCH to participate in the above described ACTIVITIES, I hereby release said
SPONSOR/CHURCH, its agents and employees, from all actions, causes of action, damages, claims, or demand which I, my heirs, executors, administrators, or assigns may have against
said SPONSOR/CHURCH, THEIR AGENTS AND EMPLOYEES, and other above described parties for all personal injuries known or unknown which the participant named above, has or may incur by
participating in the above described ACTIVITY. I, the undersigned, have read and understand all its terms. I execute it voluntarily and with full knowledge of its significance.
By entering your name you are agreeing with this Medical Release & Activity Waiver.
Your Email Address
in the box to the right »
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