The Hill Summer Camp

Registration type

$525.00

Pay in Full

$100.00

Deposit

Prices are in USD.

Who’s this registration for?

First name

Last name

Email address

Contact phone

Additional Information

Full Mailing Address

Grade (just finished)

T-Shirt Size

Gender

Student you'd like to room with

Parent/Guardian Info

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Parent/Guardian Phone Number

Secondary Emergency Contact First and Last Name

Secondary Emergency Contact Phone Number

Insurance Information

Physician's Name

Physician's Phone Number

Insurance Company

Insurance Policy/Group #

Allergies, Special Needs, & Additional Information

1910 Church Waiver

The above student has my permission, as parent/guardian, to attend this function with 1910 Church. I agree that 1910 and/or its leaders are not liable for any accident related to either the planned event or transportation to or from that event. Nor are they liable for any injuries sustained or any lost, stolen, or damaged articles. I also agree that my child will be responsible to 1910 Church and its leaders for all of his/her actions on this event. I authorize 1910 and any adult leader to obtain the services of a physician and/or hospital for the care of my child, if necessary, including emergency medical care, emergency x-rays, and/or emergency surgery. Should the need arise, I also authorize 1910 Church and its leaders to incur any necessary expenses for such services in the event of accident or illness, and I agree to provide payment for those expenses.

I agree to these terms