Camper Name

First Name

Last Name

Mom's Name

First Name

Last Name

Mom's Phone

(###)

###

####

Dad's Name

First Name

Last Name

Dad's Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

EMERGENCY AUTHORIZATION: If I cannot be reached I, the undersigned parent or legal guardian of the participant, hereby authorize the teachers, assistants, and event staff as my agents to consent to medical treatment in the case of injury or medical emergency. WAIVER OF LIABILITY AND DISCLAIMER: I, the parent or legal guardian of the participant, acknowledge that participation in this event involves the risk of injury. I further acknowledge that this event is primarily administered by volunteers. In consideration for accepting the registration for the participant listed and for permitting voluntary participation of the said individual in its programs, I hereby release, discharge, and hold harmless the event staff its sponsoring organization, its employees, volunteers, and other representatives from any claims arising out of or related to any physical injury that may occur to the said individual while participating in this event. PHOTOGRAPHY DISCLOSURE: I acknowledge that pictures will be taken of the event and its participants and I grant permission for them to be used for the promotional purposes of Big Sky Fellowship. Sign below, acknowledging these statements. *

First Name

Last Name

Date

MM

DD

YYYY