MS Camp remaining balance

May 5, 2024 1:00 PM - 10:00 PM

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Price

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Middle School Camp remaining balance

12 Remaining

Price
$235.00

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Middle School Camp remaining balance 0

Waiver of Liability, Packing List Acknowledgment, Over the Counter Medication Permission, and Electronic Device Policy Agreement

In consideration of either myself and/or my child being allowed to participate during the 2024 CIY MIX Camp held at Encounter Cove, June 13-17, 2024. I hereby for myself, my heirs, executors, administrators and assigns waive, release, discharge and covenant not to sue the First Baptist Church of Platte City, its members, employees, representatives, successors or assigns from any and all claims or liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of, my participation as in the CIY MIX Camp. This waiver of liability extends to all claims of any kind or nature, whether foreseen or unforeseen, known or unknown.

Packing List for Camp

Further, I acknowledge that I have received the packing list for this camp, and as my student prepares for the trip, I will ensure he or she packs in accordance with the stated policies.

Further, I hereby give permission to the adult sponsors, volunteers, and staff of First Baptist Church of Platte City to distribute over-the-counter medication to my child at the adult's discretion.

Finally, I acknowledge and agree to the trip's cell phone policy. Students are allowed the use of their cell phones, tablets, and other mobile electronic devices for the duration of the travel, but the adult sponsors will collect and safely store all said items upon our arrival at Encounter Cove on the afternoon of June 13th until our departure on the morning of June 17th.

Name of Student

Date

Electronic Signature

Relationship to Student

FBCPC Students 2024-2025 Annual Permission Slip

This form will be kept on file and used in the event of a problem or emergency for your son or daughter.

Please Note: Parents are responsible for ensuring that First Baptist Church has the most current information regarding their son or daughter. A new Permission Slip must be filled out and on file if there are any changes to the following: Insurance provider, doctor, meds used, emergency contacts and phone numbers, etc.

Student's First Name *

Last Name *

School Grade *

Tip: Current Grade

Home Address

Home City

Home State

Home Zip Code

Student's Mobile Number

Parent/Guardian Name(s) *

Tip: include first and last

Mobile Number (please include 2 for emergency contacts) *

Emails (include 2 guardians if applicable) *

Would you like to receive notifications for Student Ministry updates?

Text

E-mail

Student's Health Insurance Carrier *

Policy # *

Group #

In the event that I/we cannot be reached, an emergency call may be made to:

Tip: Please include name and cell #

Student's Date of Birth *

Date of Last Tetanus Injection

Current Medications *

Allergies *

Any special medical instructions?

Any special needs?

I give my consent for my student to participate in Youth Group activities for February 1, 2024 to Januraury 31, 2025. In the event of an emergency affecting the health or welfare of this participant, the sponsors, leaders, or adult chaperones have permission to administer first aid and/or transport the individual to the nearest doctor or hospital for further medical attention, as deemed necessary. The individual action in response to the emergency will be held blameless. Any medical expenses occurring will be borne by the parents or guardians of the participant.

Electronic Signature *