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Carolina Creek Christian Camp
Participation Agreement & Waiver
Name of Camp Participant
I am above the age of 18 and am signing this agreement as the camp participant.
I,
, am the parent/legal guardian of the came participant, a minor.
I hereby acknowledge that said minor is presently under my care, custody, and control. I hereby give my child my permission to
attend Carolina Creek Christian Camp.
Furthermore, I consent to give my child permission to participate in all activities including, but not limited to, climbing, repelling, low
rope elements, high rope elements, swimming, other water activities, and all indoor and outdoor events and activities. I understand all
activities are optional and that my child or I have voluntarily applied to participate in the events and activities of the Camp. I
understand the foregoing activities and all other events, hazards or exposures connected with the Camp and the indoor and/or outdoor
activities, involve risk of harm and that accidents or illness can occur in places without medical facilities, physicians, or surgeons. I
am aware of the risks and damages inherent with those activities and I knowingly and willingly assume the risk of injury.
Medical Information
Participant Name:
Mailing Address:
City:
State:
Zip:
Date of Birth:
Phone:
Person to notify in case of an emergency:
Phone number(s) of emergency contact person:
Name of doctor and phone number:
General Health Information: Do you currently have any of the following?
1. Recent serious injury: Y
N
2. Recent surgery: Y
N
3. Allergies to medications: Y
N
4. Food Allergies: Y
N
5. Asthma: Y
N