Gen Now Youth Camp • Rock Solid Church

*If your teen has prescription medications, please be sure to clearly label them with instructions and hand it directly to Chelsea at drop off, prior to leaving your teen.

Question? Contact Ethan or Chelsea Tomlinson

Date & Time

August 15, 2020 10:00 AM - August 16, 2020 2:00 PM

Type

Price

Quantity

Youth Camp Attendance

Price
$50.00

Quantity

Youth Camp Attendance 0

Registration Information

First Name *

Last Name *

Preferred Name

Date of Birth

Overnight Issues? *

Tip: Is there anything we should know regarding overnight issues?

Other concerns/information regarding your teen?

Tip: List anything we should know about your teen while they are in our care.

Parent/Guardian Full Name (first & last) *

Address *

Phone Number *

Tip: NO dashes and must include area code: Example: 5185557515

Cell Number *

Tip: NO dashes and must include area code: Example: 5185557515

Email Address

Picture Release

I do hereby authorize Rock Solid Church and its staff and volunteers to post pictures, images and likenesses of my minor child listed above for use in publications, including but not limited to newspapers, magazines, church bulletins and newsletters, advertisement, web postings, and any other use in keeping with the nature of church activities.

Name of Youth *

Parent/Guardian Full Name *

Today's Date

Medical Release Information

Emergency Contact *

Tip: In the event we are unable to reach the parent/guardian listed, who should we contact?

Emergency Contact Phone Number *

Tip: NO dashes and must include area code: Example: 5185557515

Physician Name *

Physician Phone # *

Tip: NO dashes and must include area code: Example: 5185557515

Name of Insurance Company *

Policy # *

Allergies or restrictions? Asthma, Diabetes, etc.? Prescription Medicine? *

Tip: Please list anything the camp counselor should be aware of when caring for your child during this trip. All medications should be handed to the counselor at drop off!

I understand that, in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give my permission to the leaders of Rock Solid Church or an adult supervisor to secure the services of a licensed physician to provide the care necessary, including anesthesia, for my child’s well-being.

Parent/Guardian Full Name

Today's Date

Waiver of Liability Statement

I, the parent or legal gaurdian of the child listed below release Rock Solid Church, together with the adult leaders, from any and all claims resulting from injury or damage that may be sustained by my child while participating in the activity listed below.

Name of Youth *

ACTIVITY: GENERATION NOW YOUTH CAMP (AUGUST 15TH-16TH, 2020)

Parent/Guardian Full Name *

Today's Date *