Summer Camp & Activities Registration Form

  • Does the participant have any Allergies, Chronic Illness, or Medical Conditions?

  • Is the participant prescribed an inhaler? Please explain instructions below.

  • Informed Consent and Acknowledgement

    I hereby give my approval for my child’s participation in any and all activities prepared by Church of the Rockies and Legacy of Faith Ministries, Inc. during the dates of the event described herein. In exchange for the acceptance of said child’s candidacy by Church of the Rockies and Legacy of Faith Ministries Inc., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Church of the Rockies and Legacy of Faith Ministries, Inc. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected retreat sessions. In case of injury to said child, I hereby waive all claims against Church of the Rockies and Legacy of Faith Ministries, Inc. including all chaperones, coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including but not limited to skiing, basketball, baseball, football, and soccer. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

  • Medical Release and Authorization

    As Parent and/or Guardian of the named participant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of a medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to a qualified and licensed medical physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Church of the Rockies and Legacy of Faith Ministries, Inc. and its affiliates including Chaperons, Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. This release is authorized on the dates and/or duration of the registered event. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

  • Confirmation

    BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

  • Permission to Use Photograph

    Event: Summer Camps and Activities

    Location: Red Lodge, MT

    I grant to Church of the Rockies and Legacy of Faith Ministries, Inc., the right to take photographs of me and my family in connection with the above-identified event. I authorize Church of the Rockies and Legacy of Faith Ministries, Inc. its assigns and transferees to copyright, use and publish the same in print and/or electronically.

    I agree that Church of the Rockies and Legacy of Faith Ministries, Inc. may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

    I have read and understand the above:

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