Centrifuge: July 16-21, 2016
Centrifuge: July 16-21, 2016 Early Registration: $375 if $100 deposit turned in by June 8th $415 after June 8th
Registration Form
Parental Contact Information Parent Name
Student Name
Grade/Sex/T-shirt Size (adult sizes)
Address
Address City , State, Zip Code City , State, Zip Code
Home Phone
Home Phone Cell Phone
Amount paid
______________________________________________ E-mail
Method of Payment
Cash
Check
Online
Make Checks Payable to: Lifepointe Church Online at: http://www.lifepointecommunity.com/ministries/students
Received by:_______________ date:________
Summer Camp Participant Release and Assumption of Risk I,___________________________________________, parent / guardian of ___________________________________ give permission for my / my son’s / my daughter’s participation in the 2016 Summer Camp to be held by Lifepointe Community Church July 16-21th, and represent and agree that: 1. I understand that participants in the Summer Camp will stay overnight at the Aldersgate Camp and be involved in activities such as scheduled recreation, worship, scavenger hunts, games, team time with team leaders, various activities, and Bible teaching. 2. I am aware of the potential hazards and risks to my person / my son / my daughter and property associated with participating in the Summer Camp, such hazards and risks including, but not being limited to illness, injury or death by accident. I accept my / my child’s participation in the Summer Camp with full awareness of these risks and I agree on behalf of myself and my son and/or daughter that neither I nor they will make a claim or bring legal proceedings against Lifepointe Community Church in connection with my or their activities or participation in the Summer Camp. With respect to Lifepointe Community Church and its agents, officers, volunteers, directors, and employees, I voluntarily, [on my child’s behalf,] assume all hazards and risks and any damage to my personal property, and on behalf of myself and my child, I release Lifepointe Community Church and its agents, officers, directors, and employees from any liability that I / my son / my daughter may suffer as a result of participation in the Summer Camp. 3. I attest and certify that I / my son / daughter have no medical conditions that would prevent me / him / her from participating in the Summer Camp. 4. I am aware of the hazards and risks to my person / my son / my daughter associated with participation in the Summer Camp, as described above. I further understand that Lifepointe Community Church does not have any insurance coverage that would apply in the event of illness, injury or death, or damage to my property that may occur during or as a result of my / my son’s / my daughter’s / participation in the Summer Camp, and that if I desire insurance coverage I am responsible for obtaining and paying for such insurance for myself / my son / my daughter. 5. I expressly agree that this assumption of risk agreement is intended to be as broad and inclusive as permitted by law. I further state that I have carefully read the foregoing assumption of risk and understand its contents, and I voluntarily sign this release as my own free act on behalf of myself and each child of mine. This is a legal document and I understand that Ii have the opportunity to consult with an attorney before signing it. (Parent/guardian/adult participant) Signature:_______________________________________________________ Date _______________________
Registration Form
Parental Contact Information Parent Name
Student Name
Grade/Sex/T-shirt Size (adult sizes)
Address
Address City , State, Zip Code City , State, Zip Code
Home Phone
Home Phone Cell Phone
Amount paid
______________________________________________ E-mail
Method of Payment
Cash
Check
Online
Make Checks Payable to: Lifepointe Church Online at: http://www.lifepointecommunity.com/ministries/students
Received by:_______________ date:________
Summer Camp Participant Release and Assumption of Risk I,___________________________________________, parent / guardian of ___________________________________ give permission for my / my son’s / my daughter’s participation in the 2016 Summer Camp to be held by Lifepointe Community Church July 16-21th, and represent and agree that: 1. I understand that participants in the Summer Camp will stay overnight at the Aldersgate Camp and be involved in activities such as scheduled recreation, worship, scavenger hunts, games, team time with team leaders, various activities, and Bible teaching. 2. I am aware of the potential hazards and risks to my person / my son / my daughter and property associated with participating in the Summer Camp, such hazards and risks including, but not being limited to illness, injury or death by accident. I accept my / my child’s participation in the Summer Camp with full awareness of these risks and I agree on behalf of myself and my son and/or daughter that neither I nor they will make a claim or bring legal proceedings against Lifepointe Community Church in connection with my or their activities or participation in the Summer Camp. With respect to Lifepointe Community Church and its agents, officers, volunteers, directors, and employees, I voluntarily, [on my child’s behalf,] assume all hazards and risks and any damage to my personal property, and on behalf of myself and my child, I release Lifepointe Community Church and its agents, officers, directors, and employees from any liability that I / my son / my daughter may suffer as a result of participation in the Summer Camp. 3. I attest and certify that I / my son / daughter have no medical conditions that would prevent me / him / her from participating in the Summer Camp. 4. I am aware of the hazards and risks to my person / my son / my daughter associated with participation in the Summer Camp, as described above. I further understand that Lifepointe Community Church does not have any insurance coverage that would apply in the event of illness, injury or death, or damage to my property that may occur during or as a result of my / my son’s / my daughter’s / participation in the Summer Camp, and that if I desire insurance coverage I am responsible for obtaining and paying for such insurance for myself / my son / my daughter. 5. I expressly agree that this assumption of risk agreement is intended to be as broad and inclusive as permitted by law. I further state that I have carefully read the foregoing assumption of risk and understand its contents, and I voluntarily sign this release as my own free act on behalf of myself and each child of mine. This is a legal document and I understand that Ii have the opportunity to consult with an attorney before signing it. (Parent/guardian/adult participant) Signature:_______________________________________________________ Date _______________________
