Flow Forms

Child's Name

required

Date of Birth

required

Age

required

Street Address

required

City

required

State

required

Zip

required

Parent/Guardian Name

required

Parent/Guardian Phone Number

required

Parent/Guardian Email

required

Emergency Contact Person

required

Someone other than parent

Emergency Contact Phone Number

required

Does your camper have allergies?

required

Yes

No

List Allergies

If you answered yes to the question above, please answer this question.

Does your camper take prescribed medications?

required

Yes

No

Prescribed medications

If you answered yes to the question above, please answer this question.

Does your camper have any emotional issues that staff should know about?

required

Yes

No

Emotional Issues

If you answered yes to the question above, please answer this question.

Is your camper taking any medications to treat these conditions?

required

Yes

No

Medications to treat conditions

If you answered yes to the question above, please answer this question.

Has your camper had Covid 19 in the past 14 days?

required

Yes

No

Has your camper been exposed to anyone with Covid 19 in the past 14 days?

required

Yes

No

Does your camper need transportation to The Ahman Christian Sports Camp?

required

Yes

No

If yes, please contact the church office.

Photo Release

required

I hereby give permission for my child to be photographed during The Ahman Christian Sports Camp/Clinic. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or for promotional purpose including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Community Baptist Church.

Consent, Release and Acknowledgement

required

I hereby give my permission for my child’s participation in any and all activities prepared by Community Baptist Church during the selected camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Community Baptist Church 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 camp sessions. In case of injury to said child, I hereby waive all claims against Community Baptist Church including all directors, instructors, affiliates, participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. I am aware there is a risk of being injured that is inherent in all sports activities.

Medical Release and Authorization

required

As Parent and/or Guardian of the minor child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of medial emergency, which in the opinion of the attending 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 the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the minor child. 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 g 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 Community Baptist Church and its affiliates including directors; and instructors to provide the needed emergency treatment prior to the child’s admission to the medical facility. 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.

Parent Signature

required

Date signed by parent

required

Ahman Christian Sports Camp

Medical History

Transportation