fuge summer camp 2023 Youth FUGE Summer Camp 2023 "*" indicates required fields Step 1 of 3 - Personal Information 33% Campers InformationCamper 1 Name* First Last Camper 1 Birthdate* MM slash DD slash YYYY Camper 1 Grade (entering Fall 2023)*Camper 2 Name First Last Camper 2 Birthdate MM slash DD slash YYYY Camper 2 Grade (entering Fall 2023)Camper 3 Name First Last Camper 3 Birthdate MM slash DD slash YYYY Camper 3 Grade (entering Fall 2023) Parent/Guardian InformationParent/Guardian Name* First Last Parent/Guardian Email* Parent/Guardian Phone*Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Would you like to receive calendar event emails for all LifeWay Youth Events? Yes No Emergency Contact and Medical InformationPlease list any allergies, medications, medical information, or chronic illnesses your child may have. Please write "NONE" if there are no special circumstances or information that we need to be aware of.*Emergency Contact Name* First Last In case of emergency, if parent is not available.Emergency Contact Phone*In case of emergency, if parent is not available.Does your child have medical insurance?* Yes No Insurance Company and Policy #* Photo/Video Release: Do you give permission for LifeWay Church to use your child's image(s) and name(s) associated with online or print marketing for LifeWay Church or future camps?* Yes No General Release and Hold Harmless Agreement The undersigned, being the legal guardian of participants listed above give permission for my youth to attend Summer FUGE Camp located at Aldersgate Conference Center in Turner, OR from July 15-20th. You, being the legal guardian of participant, hereby give your permission for LifeWay to take said participant to a doctor or hospital; you also hereby authorize the medical treatment of the participant, including transportation to and from LifeWay Church, to Aldersgate Conference Center. You further authorize treatment by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life and/or cause disfigurement, physical impairment, or undue discomfort if delayed. You will assume responsibility of all medical bills, if any. This authority is granted only after a reasonable attempt has been made to contact you. You understand and acknowledge that the Church would not allow the participant to participate in such activity without releasing and holding harmless the Church. Further, in consideration of the church allowing your youth to participate in the activity, you agree to release and forever discharge the Church, their officers and directors, their employees and their agents, and any parties volunteering on behalf of the Church from all actions, claims, costs, expenses, or damages of any kind growing out of or related to this activity and the participant.General Release and Hold Harmless Agreement The undersigned, being the legal guardian of participants listed above give permission for my youth to attend Summer FUGE Camp located at Aldersgate Conference Center in Turner, OR from July 15-20th. You, being the legal guardian of participant, hereby give your permission for LifeWay to take said participant to a doctor or hospital; you also hereby authorize the medical treatment of the participant, including transportation to and from LifeWay Church, to Aldersgate Conference Center. You further authorize treatment by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life and/or cause disfigurement, physical impairment, or undue discomfort if delayed. You will assume responsibility of all medical bills, if any. This authority is granted only after a reasonable attempt has been made to contact you. You understand and acknowledge that the Church would not allow the participant to participate in such activity without releasing and holding harmless the Church. Further, in consideration of the church allowing your youth to participate in the activity, you agree to release and forever discharge the Church, their officers and directors, their employees and their agents, and any parties volunteering on behalf of the Church from all actions, claims, costs, expenses, or damages of any kind growing out of or related to this activity and the participant. Signature* Please enter your full name as a signature for this formDate* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
