* I hereby agree and declare that I am the legal parentguardian of the above-named child and hereby consent to the child's participation in the activities that are described to me in registration process. I understand that activities of the kind described may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.
*If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).
*I, the parent/guardian, hereby agree and declare that I have carefully read and understand the scope of the summer camp activities and I consent to the participation of the above-named child to these activities.
* Any type of injury that may occur to the child without the fault of the camp management and activity supervisors, the camp management cannot be held responsible for any harm that may occur to the child without the fault of the camp management and activity supervisors.
*I understand that my image may be photographed or filmed and consent to use of the same in video presentations and printed publications of TCITP or any of its Ministries; including, without limitation, their internet websites. Please note your full name will not be used in these publications.
* We verify that this form has been truthfully completed to the best of our knowledge. We hereby give permission to the physician or dentist selected by The Church in the Pines (TCITP) staff to hospitalize, secure proper treatment and/or order an injection, anesthesia, or surgery, and disclose protected medical information to TCITP staff and medical volunteers for the purpose of treating the health and well being of the aforementioned person. We realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment, and we accept and assume any such risk for and on behalf of ourselves and said minors. We understand that the information used or disclosed may be subject to re-disclosure by TCITP staff or medical volunteers receiving it, and would then no longer be protected by federal privacy regulations. We may revoke this authorization by notifying TCITP in writing of our desire to revoke it. However, we understand that any action al-ready taken in reliance on this authorization cannot be reversed, and our revocation will not affect those actions. We understand that attempts will be made to contact me in the most expeditious manner possible. Permission is also granted to TCITP staff to provide needed emergency treatment to the student prior to admission to a medical facility. This authorization begins upon departure to camp, retreat, or activity within the effective dates specified on this form and expires upon return from said camp, retreat, or activity.
* TCITP is not responsible for the loss or theft of personal belongings.