Timberkids Camp - August 1-4, 2023

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 TIMBERKIDS CAMP 2023 and participate in all planned activities.

RETREAT VIDEO AND PHOTO RELEASE

You understand that during the retreat/event with Timberkids 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 Timberkids/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 Timberkids/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 *

Address *

Address Line 2

City *

State *

Zip *

Student Birthday*

Gender*
Male
Female

Campus*
Fort Collins
Windsor
Other

Name of Insurance Company*

Policy #*

Physician's Name*

Physician's Phone*

Allergies*

Please list any and all allergies that your student has

Medications

Please list any current medications the camp nurse will distribute to your child.

Emergency Contact *

Relationship to Child*

Emergency Contact Phone Number*

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.

Timberkids Camp - August 1-4, 2023

Who will be participating?

Parent / Guardian Information

Please enter participants' full names: