SUMMER CAMP REGISTRATION

BTWF is pleased to offer our Summer Camp and After School Program for those families that need care for their children beyond the normal school day hours. This program is available for all ages 5 yrs. old – 12 yrs. old. This program runs from June 12, 2023 – August 4th, 2023, from 6:30am – 4:30pm Monday- Friday with scheduled holiday closing. Breakfast, lunch, and snack will be provided to students.

Please complete and submit one form per student being enrolled in the After School and Summer Camp Program.

Parent's Name

Parent's Phone Number

Street Address

City

Region/State/Province

Postal / Zip code

Parent's Email

Student's Name

Student's Birth Date

Gender:

What the name is your child's school information:

School Phone Number

School Address

Region/State/Province

City

Postal / Zip code

If yes, can you please tell us about it and submit a copy for our records

What time should your child will arrive to after school:

Please specify each person, including the name of parents, who has permission to pick up your child from the After School and Summer Camp Program. Who also can be called incase of an emergancy.Please notify the Director in writing if anyone other than a parent/guardian will pick up your child.

Authorized Person 1:

Phone Number 1:

Authorized Person 2:

Doctor's name?

Authorized Person 1:

Authorized Person 2:

Phone Number 2:

Incase of emergency what hospital to take your child to:

Doctor's Address

City

Region/State/Province

Postal / Zip code

Who is your child's insurance provider and number:

Do your child have any health issues:

Please note any known allergies:

ANY OTHER SPECIAL NEEDS, REQUIREMENTS OR DIRECTIONS THAT WOULD BE HELPFULFOR THE LEADERS TO KNOW ABOUT YOUR CHILD:

It is understood and agreed that BTWF (Believers Temple Word Fellowship) and their partners reserves the right to take and utilize pictures, likenesses, videos, and testimonials of participants for promotional purposes including, but not limited to reports, publications, brochures, emails, our website, and other instances of online presence. I grant BTWF (Believers Temple Word Fellowship), its agents and the news media the right to photograph me and/or my family including children and to use the photograph for news and publicity purposes. I agree to my child participating in BTWF (Believers Temple Word Fellowship) programs and that he/she will comply with all rules and regulations. I further agree that I will not hold the BTWF (Believers Temple Word Fellowship), its directors, officials, agents, employees, and volunteers responsible in case of accident or injury. I understand that no accident insurance is provided. I also agree to abide by the BTWF (Believers Temple Word Fellowship) standards and guidelines. I give my consent for my camper to be photographed.

Statement of Policy

Please specify each person, including the name of parents, who has permission to pick up your child from the Summer Camp and After School Program. Who also can be called in case of an emergency. Please notify the Director in writing if anyone other than a parent/guardian will pick up your child.

LIABILITY WAIVER, INDEMNIFICATION & PERMISSION AGREEMENT

For the Summer Camp and After School Program programs and collaborating partners.

I fully release and discharge BTWF (Believers Temple Word Fellowship) along with their collaborating partners, employees, directors and volunteers from any and all claims or damages, including claims or damages arising from injuries, death or property damage, which may arise out of or occur in connection with my use of the facilities the programs offered by BTWF (Believers Temple Word Fellowship) or affiliates or allegedly caused by the negligence of BTWF (Believers Temple Word Fellowship) and all affiliates except for those resulting from the intentional or reckless acts of the Link BTWF (Believers Temple Word Fellowship) or its employees, directors and volunteers.

I further agree to indemnify and hold harmless BTWF (Believers Temple Word Fellowship) along with their collaborating partners, employees, directors and volunteers from any and all claims or damages, costs or expenses, incurred by BTWF (Believers Temple Word Fellowship) along with their collaborating partners, employees, directors, affiliates, contractors and volunteers which result from or relate to my use of BTWF (Believers Temple Word Fellowship) facilities and the programs offered by BTWF (Believers Temple Word Fellowship) along with their collaborating partners except for those resulting from the intentional or reckless acts of BTWF (Believers Temple Word Fellowship) along with their collaborating partners, employees, directors and volunteers.

I have been offered the opportunity to negotiate the terms and conditions of this liability waiver and indemnification agreement; however, I choose to accept the terms and conditions of this agreement as they are, without negotiation.

In addition to my participation in general activities programs, I acknowledge that certain risks apply when participating in the BTWF (Believers Temple Word Fellowship) Activities The undersigned hereby recognizes and acknowledges that certain risks of physical injury and property damage exist when participating in the programs offered by BTWF (Believers Temple Word Fellowship) along with their collaborating partners, employees, directors and volunteers including but not limited to the drowning while swimming, and death or serious injury from diving, swimming for extended periods of time or great distances, or falling while participating in other activities offered BTWF (Believers Temple Word Fellowship) along with their collaborating partners, employees, directors, and volunteers. I agree to release all claims of injury or damage to or for myself or my child/ward arising from the negligence of BTWF (Believers Temple Word Fellowship) and any of its directors, officers, affiliates, contractors, employees, or volunteers. I acknowledge that I have been provided with adequate time to read this release, obtain any advice I might need, and bargain for the opportunity to participate in activities without signing this release.

I have read and understand STATEMENT OF POLICY and LIABILITY WAIVER, INDEMNIFICATION & PERMISSION AGREEMENT contained here

I accept terms & conditions

Your Signature

Todays Date: