$25.00

Camper Information:


Parent/Guardian Information:



Medical Information:


Please read the following information carefully and indicate your agreement:

I am attending Summit 2022 and I will gladly participate in all activities, respect others, and obey all camp rules. I understand that failure to comply with these standards could result in dismissal from camp without refund.

1. Subject: Participant recognizes and expressly agrees that participating in any sport or activity is inherently dangerous. Further, participant recognizes that certain safety precautions are followed, yet following these does not guarantee nor does Keep Your Heart Ministries guarantee participant’s safety.

2. Waiver and Release from Liability: Participant understands that Keep Your Heart Ministries assumes no responsibility for injuries or illnesses that participant may sustain, a.) as a result of participant’s physical condition, b.) resulting from participant’s participation in the activity, c.) as a result of another participant’s or third person’s actions, or d.) as a result of participant’s use of Keep Your Heart Ministries'/Heritage Baptist Church's facilities, field, and/or equipment in connection with this activity. The participant releases and agrees to hold harmless, defend and indemnify Keep Your Heart Ministries and its directors, staff, and supporters from and against any and all claims for personal injury (including loss of life) and all other losses or damages that the participant may suffer as a result of his or her participation and/or enrollment in Summit activities.

3. Medical Consent: Participant grants permission to Keep Your Heart Ministries and its employees and staff to take the participant to a licensed physician for medical treatment, emergency surgery, or hospitalization if participant becomes ill, sustains an injury, or otherwise requires medical treatment or attention and Keep Your Heart Ministries is unable to contact the emergency contact listed by participant. The participant gives consent to any licensed physician to administer drugs or medicine, or to perform such medical procedures as that physician determines necessary for the relief of pain and to preserve the participant’s life or health. Participant further authorizes Keep Your Heart Ministries to give first aid, CPR, or other treatment by a qualified staff member to participant.

4. Property Loss: Participant understands and agrees that Keep Your Heart Ministries is not responsible for personal property that is lost, damaged, or stolen in connection with this activity.

5. Binding Effect: The agreement shall be binding upon participant, his or her heirs, estate, successors, and legal representatives.

6. Acceptance: If any portions of this waiver and release are held to be invalid, participant agrees the remaining terms shall continue to be in full legal force and effect. Participant understands and agrees that this waiver and release is binding upon me and my heirs, estates, and legal representatives.

I grant Keep Your Heart Ministries the absolute right to copyright, re-use, publish, and republish by any medium, including electronically, any photos or videos of my child or in which they may be included, that may be taken while participating in Summit activities.

$2.00
$27.00
$27.00


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