Emmanuel Pines
$95 before 1/31
$110 after 1/31
Event Registering for *
Student Name *
Home Address *
City/State/Zip *
Primary Parent Cell *
School *
Grade *
Parent's Email *
1st Contact's Name *
Address *
Relationship to Student *
2nd Contact's Name *
Cell Phone *
In registering for this trip, I agree to abide by The Grove Bible Church's standards of Christian conduct, which includes wearing of modest clothing, using clean language, and being a part of ALL scheduled activities. I WILL NOT bring tobacco, drugs, alcoholic beverages, any types of weapons, potentially dangerous items or any type of inappropriate media to church activities. I understand that any violations will result in my being sent home at my own expense.
Student's Name *
Date *
(that the student agrees to the terms above)
Without the following information, the student cannot attend the church event.
Medical Insurance Co. *
Policy # *
Family Doctor *
Doctor's Phone # *
Allergies/ Special Instructions *
We realize that no activity is without the possibility of unforeseen hazards, which could result in injury to an individual. For this reason, The Grove Bible Church provides supervision and directions for the safe conduct of our church activities. Sometimes these directions are not followed or are disregarded by students in our programs, resulting in injury. As a parent, or other responsible person, the Grove expects you to be aware of your responsibility to instruct your student of the importance of conduct which will insure safety and an enjoyable time while at church activities. By signing this form, you, as a parent, guardian, other responsible person, agree to assume the risks and hazards, which may be inherent in activities. You also agree to absolve and hold harmless The Grove and/or its owners, agents or employees for damage, losses or injuries to student undersigned. The Grove carries accident insurance as secondary insurance to individual/family coverage. I understand that I am signing for the minor listed on this form and that the signature is both a medical and liability release. If and accident should occur which causes a dispute between The Grove and myself, I agree not to press charges in a court of law, but will submit to arbitration by a representative of an organization established for such purpose, agreed to by both parties. In the event I cannot be reached in an emergency, I herby give my permission to the physician or dentist selected by The Grove to hospitalize, secure proper treatment and/or injections, anesthesia or surgery for my child as deemed necessary.
Parent Signature *
Date Agreed *
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Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
please pick a size for your student's shirt that comes as part of the camp registration.
(Make Checks Payable to "The Grove")
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