ATTENTION: To fully enroll your junior higher, you will need to complete the following, in order:

Part 1/3: contact info and medical waiver
Part 2/3: payment info or scholarship request
Part 3/3: Alpine Campground forms

Part 1/3: contact info & medical waiver

ATTENDEE

Attendee's name *

Attendee's name

First Name

Last Name

Attendee's email *

Attendee's phone number *

Attendee's phone number

(###)

###

####

Attendee's date of birth *

Attendee's gender *

Attendee's current grade *

Friend request (not guaranteed)

PARENT / GUARDIAN

Parent/guardian's name *

Parent/guardian's name

First Name

Last Name

Parent/guardian's email *

Parent/guardian's cell *

Parent/guardian's cell

(###)

###

####

ADDITIONAL EMERGENCY CONTACT

We will always attempt to reach out to the above parent/guardian in the case of an emergency. The below emergency contact is a backup, in case the parent/guardian cannot be reached.

Emergency Contact's name *

Emergency Contact's name

First Name

Last Name

Emergency Contact's cell *

Emergency Contact's cell

(###)

###

####

MEDICAL FORM & LIABILITY RELEASE WAIVER

General issues (if any)

Allergies to food/medication (if any)

*Relevant* illnesses & medical treatments (if any, please indicate dates)

Prescribed medication (if any)

Should attendee take any medications during events? If yes, please list and explain

Date of attendee's last tetanus shot

YYYY

Do you know of any health factors that make it advisable for attendee to follow a limited program of physical activity? (if any, please list)

Liability Release *

I/we the parent(s) or legal guardian(s) of the above named student do hereby give consent to said student to participate with Refuge Calvary Chapel Huntington Beach (hereby Refuge) and the Youth Ministry in any and all church events including camps & mission trips. I realize that during events, dangers may occur which are out of the control of Refuge. I do hereby assume all the risks and will hold Refuge and it's affiliates, workers and employees harmless from any liability, actions, suits, legal or otherwise. I also acknowledge the fact that Refuge and it's workers have the right to terminate the student's participation in any event at any time as they deem necessary. The health history is correct as far as I know, and the person herein described has permission to engage in all prescribed youth activities except as noted by me and/or my physician. In the event of a minor illness or injury (cold, headache, scrapes, sprains, etc.), I do authorize the staff and/or leaders to give my child common remedies such as Tylenol, cough medicine, etc. in dosages appropriate for his/her age and to clean, bandage or wrap wounds as necessary. I hereby give permission to the physician selected by the youth worker or his/her representative to order x-rays, routine tests and treatment for the health of my child, and to order injections and/ or anesthesia and/or surgery for my child named above. This authorization is given pursuant to section 25.8 of the Civil Code of California. This authorization shall remain effective through the extent of scheduled programs through December 2018. Refuge, its Board of Directors, officers, and staff are hereby relieved of all liability in the event of accident or injury to said participant.

I've read the above fine print and consent

I do not consent

Please enter your name and today's date as your digital signature. *

Click here to pay remaining balance

Camp Sign-up: Junior High

ATTENTION: To fully enroll your junior higher, you will need to complete the following, in order: