St. Peter's at-the Light Vacation Bible School 2011
Please Read and Sign on the Reverse Side
Name of Camper:______________________________________________________________________________
Birthdate:____________________________
Parent 1 or 1st Legal Guardian's Name:_____________________________________________________________
Home Phone:_________________________________ Cell Phone:______________________________________
Parent 2 or 2nd Legal Guardian's Name:____________________________________________________________
Work Phone:_________________________________ Cell Phone:______________________________________
PLEASE READ CAREFULLY.
THIS IS A RELEASE OF LIABILITY AND OTHER RIGHTS
Although precautions are taken to provide proper organization, instruction, and equipment for your child's
participation in St. Peter's at-the light Vacation Bible School, there can be no guarantee of absolute safety against
injury and accident. There are elements of risk in any program involving physical exertion and in the use of any
equipment in connection with camp activities. I, on behalf of myself, my child (Or the child for whom I am a
guardian) and any other parent of the child, understand that my child (or the child for whom I am a guardian)
may be involved in activities including, but not limited to, beach and water activities and other camp games and
activities. I acknowledge that my child (or the child for whom I am guardian) may decline to participate in any
activity. Any participation by my child in the activities will be voluntary.
I recognize that there is inherent risk in any camp activities which involve physical exertion or risk taking. In
recognition of any risks inherent in the activities in which my child will be engaged, both seen and unforeseen, I
confirm that my child is physically and mentally capable of participating in camp activities.
I understand that my child (or the child for whom I am a guardian) will be participating willingly and voluntarily,
and I assume the full responsibility for any personal injury, accident, or illness, including death. I also assume
responsibility for the damage to or loss of personal property as the result of any accident of any kind. On
behalf of myself, my child (or the child for whom I am a guardian), and any other parent of the child, I assume
the risks of personal injury, accidents, and/or illnesses of all kinds and nature, including, but not limited to:
cuts, wounds, scrapes, abrasions, and/or contusions, sprains, or even death.
I hereby authorize any medical treatment deemed necessary in the event of an injury to my child (or to the child
for whom I am a guardian). I will have appropriate insurance or, in its absence, I agree to pay all costs of
rescue and/or medical services as may be incurred on behalf of my child.
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