Please fill out the child's information below.
Gender
*
Select Option
Male
Female
Grade (23/24 School Year)
*
Select Option
Pre-K
K
1
2
3
4
5
6
T-Shirt Size
*
Select Option
YS
YM
YL
Adult S
Adult M
Adult L
Adult XL
Primary Parent/Guardian Information
Please fill out the primary parent or guardian's information here.
Relationship to child
*
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Father
Mother
Grandfather
Grandmother
Legal Guardian (a copy of guardianship papers must be provided to Wellspring Church)
Other (please describe relationship to child in box below)
Secondary Parent/Guardian/Emergency Contact Information
Please fill out the secondary parent/guardian or other emergency contact information here.
Relationship to child
*
Select Option
Father
Mother
Grandfather
Grandmother
Legal Guardian (a copy of guardianship papers must be provided to Wellspring Church)
Other (please describe relationship to child in box below)
Parent/Guardian Authorization, Consent, and Release
I, ____________________________, parent/guardian of ______________________________, hereby grant my permission for the above-named child to participate in Camp Wellspring (the “Event”) on June 19-23, 2023, sponsored by Wellspring Church (the “Church”).
I understand it is my obligation to inform the Church of any and all health considerations or medical conditions that would restrict my child’s participation in any and all activities while in the care of the Church. Should the need for medical attention arise I understand the Church will attempt to contact me as soon as practicable under the circumstances.
In cases of emergency, I further consent to the examination and treatment of my child by medical personnel as deemed necessary by such personnel. I agree to pay for any and all resulting medical expenses. I agree to waive, forever discharge, covenant not to sue and agree to hold harmless all Event volunteers and the Church, their agents, representatives, employees, sponsors, successors and assigns (“the Released Parties”), from all liability, claims, demands, losses or damages on account of or caused by, whether actual or alleged, in whole or in part, any act or omission of the Released Parties in connection with my child’s participation in the Event.
I acknowledge by signing this document I am waiving my right to maintain a lawsuit against the Released Parties on the basis of any claim from which I have released them herein. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions remain in full force and effect. I have fully informed myself as to the contents of this PARENTAL AUTHORIZATION, CONSENT AND RELEASE by reading it before I signed it.
By typing your full name and the current date, you are electronically signing this form and acknowledging that you have read the above Parent/Guardian Authorization, Consent and Release, that all repsonses in this form are true, and that your online consent is equivalent to a binding legal signature.
