Thrive Camp 2020

When: August 5-7

Where: BCC campus (No sleepover)

Cost: $40

Lunch provided each of the two days and 4-6:30pm each day is a break for students to go home and shower between games and night service

Please make checks payable to Bethesda Christian Church. Mail payments and applications to: Bethesda Christian Church Attn: Rob Susan
14000 Metropolitan Parkway • Sterling Heights, MI 48312

CONTACT ROB SUSAN: 586-876-5791

Participant's Name*

First

Last

Email address*

Household Address*

(street address, city, zip code)

Male/Female

Home Church

Pastor's Name

Date of Birth*

MM/DD/YYYY

Parent/Guardian*

First

Last

Contact Number*

Can we text this number?*

Parent/Guardian*

First

Last

Contact Number*

Can we text this number?*

In case of emergency, contact (Name)*

First

Last

Contact Number*

FULL WAIVER, RELEASE, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT By going on this event I acknowledge and understand: There are certain inherent risks and dangers my child may encounter while participating in this event, such as travel from home to begin the event, during the event and until my child returns to my home after the event, among other things, that could result in injury (whether physical, mental, social, economic or emotional), death or some type of claim or property loss. Without regard as to whether Bethesda has insurance or maintains sufficient insurance for any type of claim, damage, or loss, I agree to assume any and all risks and hazards of injury or loss arising out of or in the course of the listed event without regard to whether the risk or danger was reasonable and/or foreseeable by Bethesda. On behalf of any assignees, and myself, I release and hold Bethesda harmless from any and all liability and expense, including litigation costs and attorney fees arising out of any and all claims that I may have or later assert. In addition, I hereby waive all claims I may have against Bethesda, or any of its trustees, officers, employees, representatives, agents and volunteers (Bethesda affiliates). I shall hold harmless and indemnify Bethesda and Bethesda affiliates from any and all claims, liabilities and expenses arising out of claims later brought by any person, including third parties or my child upon attaining the age of majority, in connection with any acts or omissions of the Participant. The laws of the State of Michigan shall govern this Agreement. I understand and acknowledge I have the option of not applying to have my child participate in the listed event, and of not becoming involved in the listed event if the terms and conditions listed above are not acceptable. I HAVE READ THE TERMS OF THIS AGREEMENT, UNDERSTOOD THIS DOCUMENT AND, BY SIGNING MY NAME, FREELY, FULLY AND VOLUNTARILY AGREE TO THE SAME AS BINDING UPON ME, MY HEIRS AT LAW, NEXT OF KIN AND/OR PERSONAL REPRESENTATIVES. I further understand that during this activity an emergency can occur that may require medical evaluation and treatment. In the event I cannot be promptly contacted, I am giving permission to the adult event supervisor to select a health care facility to evaluate and/or treat any injury or illness experienced by my child. I understand that I am responsible to arrange payment for any and all expenses that may be obtained.*

I agree

I disagree

Parent/Guardian*

First

Last

Date*

DD/MM/YYYY

Medical Info

Camper Name

First

Last

Health Care Insurance Provider*

Policy #*

Contract #*

Subscriber’s Name*

(parent’s name who carries the insurance)

Present Medications*

N/A: if none.

Allergies or conditions*

N/A: if none.

This field should be left blank