JK 3rd-5th Grade Camp_2023 • Journey Church

JK 3rd-5th Grade Camp_2023 DEPOSIT 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

JK 3rd-5th Full Payment Option 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

AUTRY 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

BRIDGER_CAROLINE 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

BRIDGER_PAISLEY 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

CARY 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

GARNER 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

HERBURGER 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

PARCHMAN 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

RADER 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

ROBERTS 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

SMITH 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

VAN HOOK 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

WINSETT 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date

WRIGHT 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Emergency Contact Name (other than listed above)

Emergency Contact Phone # (other than listed above)

Camper First Name

Camper Last Name

Date of Birth

2022-2023 Grade Level

Allergies:

Medication:

Physician Name

Physician Phone Number:

Insurance Company

Insurance Policy #:

LIABILITY RELEASE FORM / RELEASE OF ALL CLAIMS

Your child is going to join us on a program involving outdoor and indoor Christian activities. We are requesting that all participants sign an Informed Consent/Release of Liability Form.

I, the undersigned, agree to let my child participate in The Grove/Journey Church programs using indoor and outdoor adventure learning activities. I acknowledge that I have been advised that he/she can decline to participate in all of, or any part of, the activities occurring during the program if he/she wish. He/she will only engage in the activities that he/she considers will not be put in physical or emotional harm. I hereby hold harmless, release and indemnify The Grove/Journey Church, its employees and its volunteers from any and not limited to, the transportation to and from the site of the activities, as well as the activities themselves and covers all the sessions of a program occurring over time. I have read this Release and understand its terms. I further represent that I am at least 18 years of age, or if I am under the age of 18, that my parent/guardian has read and signed this form below.

Parent/Guardian Signature (Type Name)

Date

I, the undersigned, grant The Grove/Journey Church and persons or organizations acting for or through them, the right to use, reproduce, assign, and/or distribute photgraphs, films, videotapes and sound recordings for use in educational or promotional materials they may create.

Parent/Guardian Signature (Type Name)

Date