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Watermarks Fall Camp

Middle School Camp (Grade 6-8): October, 13-15. Cost: $120

High School Camp (Grade 9-12): November, 10-12. Cost: $120

*Will you be attending the Middle School or High School Watermarks Camp?:
*Student's Name:
*Student's Address:
*Student Cell:
*Parent's Cell Phone:
School Attending:
*T-Shirt Size (Adult Sizes):
Two People you would like to room with (note, students are placed in same grade/gender groups):
*Parent's Email:
*Will you be playing paintball?
*Paintball is an additional $10 per student. Bring cash payment to camp, we do not take payments in advance for this activity.
*Do you have any special diet considerations?:
*If yes, please explain:
Risk Acknowledgment:
I hereby certify that I am in good physical and mental health at this time, and wish to participate in the above event/activity. I understand that my participation may result in an unexpected illness or injury, due to accidents, forces of nature, or other unforeseeable events. Such illnesses or injuries could include diseases, strains, sprains, fractures, dislocations, and/or death. These injuries (if incurred) could cause permanent disabilities. I realize that there are certain risks, including death, arising from this activity, and I am willing to assume such risks.
Video/Photo Release:
I also understand that I and/or my child(ren) may be video-taped or photographed for promotional purposes. By signing this release form, I authorize the church to use my and my family’s picture(s) (including photographic and video images) and my and my family’s voice(s) (including sound and video recordings) in any and all media and the Internet. I also waive the right to receive any payment.
Medical Release:
In the case of an emergency while the named individual is in the care of Mount Ararat Baptist Church, the church will notify the emergency persons listed immediately. In the event the church is unable to reach these persons, the church party responsible and or its designated staff is authorized to seek and obtain medical attention, treatment, and services as may be deemed necessary until the guardian arrives. The guardian agrees to pay all medical costs incurred.
In Case of Emergency Notify (other than parent)
*Cell Phone:
*Relationship to child:
Name #2:
Cell Phone #2:
Relationship to child:
Health Insurance Information
*Company Name:
*Policy #:
*Policyholder's Name:
*Family Physician's Name:
*Physician's Phone #:
Allergies (List all allergies to medicines, foods, or other things):
Restrictions (List all restricted activities):
What doctor-prescribed medicine does this person take?
I give permission to the designated leader to administer all of the following:
Other Med(s):
*Electronic Signature of Guardian (if participant is under 18 years old):