Middle School Summer Camp 2024 (May 24, 2024 - May 27, 2024)

Registering for TSM Middle School Summer Camp - 05/24/2024 12:00 AM Change

TIMBERLINE CHURCH

I understand that in the event that medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give my permission to the adult sponsors of Timberline Church to secure the services of a licensed physician, to provide the care necessary, including anesthesia, for my student’s well-being.

WAIVER OF LIABILITY STATEMENT

I, the parent or legal guardian of the student listed above, release adults in charge from any and all claims resulting from injury or damage that may be sustained by my student while participating in any/all activities. Any pictures taken of my child may be used for promotional uses within the Church. By signing this I agree to all the, above statements and give permission for my student to attend TIMBERLINE MIDDLE SCHOOL SUMMER CAMP 2024 and participate in all planned activities.

RETREAT VIDEO AND PHOTO RELEASE

You understand that during the retreat/event with TSM our staff may take photos and video footage of your student during activities. You hereby consent that photographs and/or videos involving students may be included/can be used by TSM/Timberline Church for promotional purposes, including audio-visual productions, television, billboards, email campaigns, newsletters, websites and brochures. Furthermore, you hereby consent that such images and the media from which they are made shall belong to TSM/Timberline Church, and Timberline Church shall have the right to sell, duplicate, reproduce and make other uses of such images for Timberline Church promotional purposes as Timberline Church may desire.

Who will be participating?

Adult Adult and Children Children

Parent / Guardian Information

First Name *

Last Name *

Your Date of Birth *

Phone *

Email Address *

Medical Information

Medical Information *

Please list any medications being taken, medical problems, or other pertinent information.

Allergies*

Please list any food allergies or medication allergies of your student.

Dietary Preferences*

Please list any dietary preferences for your student (non-allergies).

Name of Insurance Company*

You may be asked to provide a copy of the insurance card and the prescription card if applicable.

Policy #*

Physician's Name*

Physician's Phone*

Emergency Contact

Please provide the best contact name and phone number in case of an emergency.

Emergency Contact Name*

Emergency Contact Phone Number*

Please enter participants' full names:

Add Another Name

Sign Here

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.