Consent Form for (Child's Name) *
Consent Form for (Child's Name)
I, the parent or guardian, hereby give my permission for my child. to participate in the activities associated with an event sponsored by Capital Christian Center, including travel to and from the event location on (circle dates that apply to your child) Jr. High School July 13th-16th or High School July 16th-19th The event, known as GC High School Summer Camp, will be held at 246 Homer Ln., Donnelly, Idaho. I certify that my child is able to participate in all of the event activities, unless otherwise indicated on this release and indemnity form. If my child has medical conditions that may require treatment by a physician or other qualified medical professionals or technicians, I have listed those conditions below. If an emergency occurs, I have listed on this form telephone number(s) where I may be reached. If I cannot be reached within a reasonable time, I hereby authorize the adult on site (event sponsor ) to make emergency medical decisions for my child. I understand and hereby agree to assume all of the risks, which may potentially occur as a result of my child’s participation at this event, including activities associated with travel to and from this event. I do hereby agree to hold Capital Christian Center, Faith Heights, its agents and employees, harmless from any and all liability, actions and causes of action, claims, expenses and damages if my child is injured or my property is damaged, even injury resulting in death while participating in this event or which may become evident in the future as a result of participation in this event. I expressly agree that this release and indemnity agreement is intended to be broad and inclusive as permitted by the State of Idaho. If any portion thereof is held invalid, it is agreed by me that the balance shall continue in force legally. This release contains the entire agreement between the parties hereto, and the terms of this release are contractual and not a mere recital. I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement, which I have read and understand.
List all medications and/or special instructions:
In the Last 60 days has your child come in contact with anyone experiencing any of the following: Chicken Pox, Head lice, Fever/ Vomiting, and or any other Flu like symptoms? *
Parent/Guardian Emergency Contact Number: *
Parent/Guardian Emergency Contact Number:
Parent or Guardian Name *
Parent or Guardian Name
By entering your name you acknowledge that all you have submitted is true and that you agree to the terms and conditions listed in this document and agree to release your child into the care of Faith Heights Camp staff for any medical need that might arise. Faith Heights Camp, staff, or any affiliation is not liable for any injury or death.