2023 YAYA Camp

By checking this box I confirm that I have read, understand, and agree to the terms of attendance at Church Unstoppable.

Yes

Each household member must complete this waiver/release of liability form separately. Parents/Guardians must submit a waiver/release of liability for each child under 18 in order to participate in any Church Unstoppable event or ministry activities.

Today's Date:

Participant Name

Address

Phone

This address will receive a confirmation email

Age Range

10-17 18 and above

T-Shirt Size

S M L XL XXL XXXL

Camp Fee is $230 per person which covers lodging, meals, and a t-shirt. Deposit of $60 is due at registration but you are welcome to pay in full. Click the drop down arrow below. Balance is due on November 19, 2023.

Are you able to help or sponsor a camper this year? Donate at https://churchunstoppable.breezechms.com/give/online and select YAYA Camp. Every dollar will make a difference. Thank you.

Fee

List food allergies and any health/medical related restrictions

Is participant covered by personal/family medical insurance?

Yes No

If you answered YES to medical insurance, please complete the following questions. If you answered NO, please enter n/a in each box.

Name of Insurer

Policy or Group Number

Emergency Contact

Name of Emergency Contact

Phone Number:

Email:

PARTICIPANT AGREEMENT

In consideration for the opportunity to participate in the above activity, the participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity.

The participant (or parent/guardian) accepts personal financial responsibility for any injury sustained during the activity or during the transportation to and from the activity.

Further, the participant (or parent/guardian) promises to indemnify, defend, and hold harmless the activity sponsor or its agents, employees, volunteers, or any of its representatives for any injury related directly or indirectly out of the described activity or transportation to or from the activity, whether such injury arises out of the negligence of the Sponsor or otherwise.

If a dispute arises over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through mutually acceptable alternative dispute resolution process.

If the Participant (or parent/guardian) and the Sponsor cannot agree upon such a process, the dispute shall be submitted to a three member arbitration panel of the American arbitration Association for final resolution.

I hereby RELEASE Church Unstoppable from any and all liability, including but not limited to the claim of being exposed to covid-19, and hereby state that I attend this service at my own risk?

I Agree

I hereby give Church Unstoppable permission to edit and use quotes, photographs, audio and/or video clips of me for purposes including, but not limited to, promotional and educational materials. These materials may be used in all forms of media, including print and digital. I understand that these materials may be distributed to other individuals and/or companies, at which point Church Unstoppable will no longer have control over their use. In addition, I release Church Unstoppable from all liability related to the use of these materials. I hereby relinquish all rights to these materials.

I Agree

Electronic Signature*
By entering my name in the box below, I am providing my digital signature on this field trip waiver and release of liability form.

*Signature (A parent or legal guardian MUST sign for those under 18 years old). Full name of the above signed parent or legal guardian.

I agree with this electronic signature consent

Yes

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2023 YAYA Camp

Description

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