Camper Information Camper's Name: *
Camper's Gender: * Please select from below Male Female Camper's Age: * Camper's current grade in school: * Camper's Birthdate: *
Camper will be attending: *
***Early Bird Pricing for overnight camps is $60 until Jan. 1st.
Camper’s T-Shirt Size: * Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Parent / Guardian Information Parent / Guardian Name 1 *
Parent / Guardian 1 Email: *
Parent / Guardian 1 Best Phone Number: * Parent / Guardian Name 2
Parent / Guardian 2 Email
Parent / Guardian 2 Best Phone Number: Best Method of Contacting Parent/Guardian. Check any options that work for you. * Home Address:
* Other than Parent(s)/Guardian(s) listed above, who is authorized to pick up your camper? * Emergency Information Emergency Contact Name: (Who do we call if parent/guardian is not answering?) *
Emergency Contact Phone: * Does your child have any allergies, physical or mental health issues that we should be aware of during camp? Is your child on any medication(s)? If so, please list. Are there any custodial issues, behavioral issues, or other that we should be aware of for your child’s stay at camp? Medical Information
In the event of an accident or special health needs, it will be necessary for us to have the requested information.
Please make certain that you provide thorough and accurate medical information.
Medications you take for current medical condition (asthma, allergies, etc.) Medications you take occasionally (headaches, etc.) Do you plan to bring these or any other medications to camp with you? Please select from below Yes No
All medications must be brought in the original bottle (prescription or over the
counter), properly labeled as prescribed by law. A current Authorization to
Administer Medication MUST accompany the meds. Forms will be available when you check your child in to camp.
Do you have or have you had any of the following? If you checked any of the boxes above, please describe: Special Diet we should know about? Date of last Tetanus Shot:
Are the child's immunizations current? * Please select from below Yes No Any food allergies? Any allergies to insect bites/stings? Any other allergies we should know about? Insurance Information Family Physician: Physician Phone Number: Medical Insurance Company * Plan or Group #: * Insured ID or Member #: * Insurance Company Phone # * Medical Treatment
I, being the legal guardian give permission to The
Connection Church staff, sponsors, or designees to provide medical treatment that may be deemed necessary to insure the well-being of the named student. I, the
undersigned, do hereby verify that the above information is correct and I do hereby release and forever discharge all from any and all claims, demands, actions or
cause of action arising out of damage or injury while participating in The Connection Church sponsored events and activities.
I have read and agree with the above medical treatment statement. Please select from below Yes No Digital Signature:
By digitally signing this, you agree with the Medical Treatment Statement.
My child is in good mental and physical health
condition to participate in the activities provided Camp Chaosome. I am fully aware that any activity involving motion, height, running, jumping, or athletic activity creates the possibility of serious injury. I hereby release The Connection Church (TCC), its employees and its staff from liability to the above named camper, of the person claiming through him/her, arising from injury to the person or property of the above named camper occurring in the premises of Camp Chaosome, Twin Oaks Ranch, and The Connection Church.
I understand that The Connection Church / Camp Chaosome, has the right to deny admittance to any student not meeting the behavioral standards of the program as it sees fit. I also agree not to hold these parties responsible in the event that my child engages in inappropriate conduct (including, but not limited to disruptive or volatile behavior at camp, etc.). I acknowledge that TCC or camp staff members, have the right to send him/her home for inappropriate conduct. I further attest that the information contained in this registration form and on the required medical information form/release is correct to the best of my knowledge. I have read and agree with the above parent statement. Please select from below Yes No Digital Signature:
By digitally signing this, you agree with the Parent Statement.
AGREEMENT TO ATTEND, PARTICIPATE, ASSUMPTION OF RISK AND RELEASE OF LIABILITY
The Connection Church of Kyle, Texas hereby referred to as the “Church” requires a signature for all attendees or participants of special events and activities. Furthermore, this form releases the Church to photograph and/or use photographs of students for use in its publications, advertising, promotional purposes, internet, and/or visual presentations which inform people of the services and activities of the Church. The signature provided confirms Agreement to Attend, Participate, Assumption of Risk , and Release Form in order to participate in special events and activities.
Events and activities may include rigorous physical activities as well as exposure to the elements, animals, and insects. The Church takes all reasonable precautions to ensure a safe and enjoyable experience. The decision to attend Church events/activities and the decision to participate in any Church activity at any level IS AT ALL TIMES COMPLETELY UP TO THE INDIVIDUAL’S CHOICE, and if there is attendance at the Church event/activity and participation at any level of any Church event/activity, there is a risk, which must be assumed by each attendee and by each participant. Although it is the Church’s goal to maintain the physical, emotional and social safety of each attendee and participant of the Church event/activity, the physical, emotional and social risks must be assumed by
each attendee and participant.
“I understand that attendance of Church events and activities and participation in Church events and activities may be physically and emotionally demanding. I
recognize the inherent risk of physical and/or emotional injury of attending Church events and activities and participating in any and/or all activities. I understand
that each participant must assume the risk of any injury, physical and/or emotional, and any financial responsibility that could result from attending Church events/ activities and participating in Church events/activities. I agree to assume such risks and such responsibility. I, on my behalf, and on behalf of my heirs and assigns, hereby release, indemnify and hold harmless The Connection Church of Kyle Texas from any and all claims, physical and emotional, including bodily injury, that I may have that may be sustained in connection with my attending Church events and activities and with my participation in any and/
or all Church event activities.
I understand that the staff and/or leadership of The Connection Church of Kyle, Texas reserves the right to dismiss, without refund, any student whose influence is detrimental to the operation of events or activities. I understand that the use of alcohol, tobacco products and illegal drugs is strictly prohibited at all Church events and activities. If you feel that there are any activities which you or your child should not participate in, please describe them below. I have read (or had read to me) this complete document and I understand the information contained herein. I have freely and voluntarily signed this document. Parent/ Guardian Digital Signature:
By digitally signing this, you agree that all the above information is correct and that you agree with the assumption of risk and release of liability.
RULES FOR CHURCH EVENTS & ACTIVITIES
1. Students are not allowed to have prank supplies (i.e. shaving cream, body paint, water balloons, water guns/blasters). There are no exceptions.
2. Adult supervision is required for all water activities regardless of the student’s age or water safety ability.
3. Drugs, alcohol, any form of tobacco, firearms, knives, or any kind of weapon, or fireworks are NOT allowed.
4. Students are expected to reflect a Christian example by their dress. Immodest clothes, distasteful designs or messages, or other extreme clothes are not acceptable at any time. Students may be asked to change their attire if an adult feels their dress is inappropriate.
5. Under NO circumstances are girls allowed to be in guys rooms, or guys in girls rooms.
6. No fighting is allowed.
7. Students are to respect all adult leaders and follow their instructions. All adults are in places of authority over all students.
8. Everyone must attend all scheduled activities/events
9. Students must wear nametags at all times (if provided as part of the activity/event). Student's Digital Signature:
I have read and understand the rules for church camp.