MABC Sports Camp Registration 2019

Parent/Guardian Contact Information

Parent/Guardian 1 Name

Parent/Guardian 1 Phone

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 2 Name

Parent/Guardian 2 Phone

Parent/Guardian 2 Email

Address

Do you attend church regularly? If yes, which one?

How did you hear about camp?

Friend Online Flyer/Poster Church Other

Child 1 Information

Child 1 Name

Date of Birth

Grade (Fall 2019)

T-Shirt Size

Medical Condition/Allergies ( if no allergies, please write none)

Child 2 Information

Child 2 Name

Date of Birth

Grade (Fall 2019)

T-Shirt Size

Medical Condition/Allergies ( if none, please write none)

Child 3 Information

Child 3 Name

Date of Birth

Grade ( Fall 2019)

T-Shirt Size

Medical Conditions/Allergies ( if none, please write none)

Child 4 Information

Child 4 Name

Date of Birth

Grade (Fall 2019)

T-Shirt Size

Medical Conditions/Allergies ( if none, please write none)

Child 5 Information

Child 5 Name

Date of Birth

Grade (Fall 2019)

T-Shirt Size

Medical Conditions/Allergies ( if none, please write none)

Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone #

Emergency Contact Relationship to Camper(s)

Consent

By proceeding with this form you are agreeing to the Liability and the Emergency Aid Release waiver related to Maple Avenue Baptist Church.

Emergency Aid Release
I confirm I am the legal guardian of the camper with full authority to make decisions with respect to the care, upbringing, and education of the applicant. I agree that all the medical information provided on this form is true and accurate. I hereby release my child to the care and medical discretion of the staff at Scripture Union, Maple Avenue Baptist Church and volunteers. In the event of an emergency and that no one can be immediately contacted, my child will be taken to the hospital or a physician to be treated if deemed necessary by one of the camp staff, church staff or volunteers. I hereby authorize the physician and nursing staff to undertake examination, investigation and necessary treatment of my child.

Liability Release
I acknowledge and understand there are risks involved with my child’s participation in the camp activities, including the risk of physical injury or damage to personal property and I release Maple Avenue Baptist Church and all Scripture Union camp staff and volunteers from liability.

Parental Release

I consent I do not consent

Name of Consenting Parent or Guardian

Date of Consent

Photo Release

I understand that photographs and video recordings may be taken by Scripture Union and Maple Avenue Baptist Church which may be used in publications or promotions, including the showing of a slideshow at the end of camp and at church on Sunday. I consent to SU and MABC using the images for all stated purposes.

NOTE: If you do not consent, please speak with Camp coordinator before camp to make arrangements.

Consent

I consent I do not consent

Additional Information

Any additional information you would like us to know

Payment

Early Bird until May 31, 2019
Regisration Fee: $110/camper
Family Discount: $10 off 2nd child, $20 off 3rd, $20 off 4th

Regular starting June 1, 2019
Registration Fee : $120/camper
Family Discount: $10 off 2nd child, $20 off 3rd, $20 off 4th

Payment

MABC Sports Camp Registration 2019

Description

Please Fix the Following