Makers Camp Registration

Makers Camp Registration Form

Participant Information

If 'no' is selected, please fill out course options.

Parent/Guardian Information

If no, please fill out address below

Health/Insurance Information

Other than parent/guardian
If the participant suffers from allergies, please list them along with wheather or not he/she has a risk of anaphylaxis and the requirement of an Epi-Pen.
If the participant requires medication, please list them along with dosage instructions.
If yes, please select which ones below.
If yes, please fill out insurance information.

Course Registration

We will do our best to place your child in the first choice, but spots are limited.
We will do our best to place your child in the first choice, but he/she may be placed in your second or third choice, since spots are limited.

Authorization:

Medical & Liability Release–

I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by New Covenant Church/ Makers Camp 2018, hereinafter, referred to as the Church.  I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may over during the corse of my/our child’s involvement.  In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician.  In the event treatment is required from a physician and /or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent.  I/we also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider.  Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above.  I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the camp staff member.  Further, I/we authorize the Church to use our child’s likeness in photographs or video in any and all of its publications and in any and all other media.  I/we will make no monetary or other claim against the Church for the use of such photographs, video or live-streaming webcast.