Camp Tulahead - Registration and Consent Form (To be completed for Youth under 19) October 12-14, 2012

By signing this form I understand that my child, ________________________________, will be participating in the Camp Tulahead retreat from October 12, 2012 at 5pm to October 14 around 3pm. Transportation and supervision will be provided by the staff of Chilliwack Baptist Church.

Consent I consent to my son/daughters attendance and participation in the Camp Tulahead Retreat. In the event of a medical emergency, I understand that an effort will be made to reach me. However, I give the leaders of the church youth ministries the authority to act on my behalf and to authorize treatment for my child if necessary during the event that the parent/guardian is unable to provide such consent. I also understand that I am liable and agree to pay for all costs and expenses incurred.

I release the church (paid and non-paid staff, members, and volunteers) and event-related companies and staff against all losses, claims, suits, and demands, or any liabilities whatsoever arising from injury or death to the child or other persons involved.

I understand that Chilliwack Baptist Church will collect and securely retain the above information for record-keeping purposes. I give permission for my childs picture and/or name to appear, on occasion, on promotional or invitational materials or website affiliated solely with Chilliwack Baptist Church.

Parent or Guardian: ________________________________________________________ Signature: ________________________________________________________ Date: ______________

46336 First Avenue Chilliwack, B.C. V2P 1W7 Telephone: 604-792-3988 Fax: 604-792-9053 e-mail:theoffice@chilliwackbaptist.com