Cave Spring Baptist Church

Fees

Review

Finish

We are excited about our Middle School Camp designed to provide a variety of activities to entertain the interests of all of our campers! Camp is for rising 6-8th grade.

June 22 - June 25 from 9:00am -1:00pm. Cost: $45

Special Daily Activities

Mon – Nerf War

Tues – Mill Mountain Zoo

Wed – Putt Putt

Thurs – Slip n’ Slide

If you have questions please contact us at 540-989-6136 or lmarceau@csbcroanoke.com

We cannot guarantee a t-shirt for registrations received after June 5.

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Child Information

Child's First Name *

Child's Last Name *

Grade Level*

Date of Birth *

Medical or other info we need to know (include food allergies)*

	None
	Gluten Free
	Allergies
	Carry Epipen
	ADHD or ADD
	Autism Spectrum Disorder
	Diabetes
	Mobility Challenges
	Other

Comments: Anything else we need to know about your child?

What size t-shirt?*

Parent / Guardian Information

Parent / Guardian Name *

Cell Phone (xxx-xxx-xxxx format) *

Email *

Verify Email *

Emergency Contact & Pick Up Information

Emergency Contact *

Emergency Contact Phone *

Pick-up Person #1 *

Pick-up Person #2

Waivers

Waiver Acceptance
Please read and sign the below liability, medical and media waivers.

Liability Waiver: In consideration of the privilege of my child’s participation in all activities associated with Cave Spring Baptist Church’s Kids Camp, I hereby release, discharge, hold harmless and indemnify, and covenant not to sue, Cave Spring Baptist Church, and all of the staff, officers, deacons, employees, volunteers, insurers, agents, and representatives, and all other persons associated with the program as to any and all claims  of my child, me and other family members for personal injuries suffered by my child, property damage, medical expenses, and economic loss arising directly or indirectly out of my child’s participation in camp, and any first aid, medical care or treatment provided to my child in the event my child becomes injured or becomes ill while participating in program activities, and excepting claims that may not be released under applicable law. This Release of Liability shall be as broadly construed as allowed by the law to include all claims and rights that the child, that I as parent/guardian, and that other family members may have. If any provision of this Release of Liability is deemed invalid, the remaining provisions shall remain in full force and effect. This Release of Liability shall be binding on me, my family, heirs, next of kin, legal representatives, beneficiaries, successors and assigns.   Medical Waiver:  In the event that my child is injured or becomes ill in Program activities, and if I, the parent/guardian, am not present to make medical decisions, I hereby authorize the CSBC volunteers including parent participants, and staff to arrange for and consent on my behalf to emergency medical and dental care and treatment, including test, radiological exams, surgery, hospital care and treatment, and to consent to medications for pain and other conditions as prescribed by medical personnel attending my child. I am responsible for payment of any medical charges or expenses not covered by my insurance or the applicable insurance to my child. Photography, Audio and Video Permission:  I give permission for CSBC to take pictures and videos of my child during CSBC activities. Further, I hereby transfer and assign to CSBC the exclusive right to use and to authorize others to use said images and video recordings for promotional and educational use or resource sale in the future, but my child’s name or personal information will not be published.

Acceptance:*
Full Name:*