ZOE Family Ministries Application

Participant Information

* = Required
*Participant First Name: *Paticipant Last Name:
*Date of Birth: *Age:
*Address: *City:
*State: *Zip Code:
*Applicant Cell Phone:
*Applicants Email: *School Attending:
*Grade: *Hobbies:
*Are you a born again child of God? (Y or N) When:
Where: At what age:
*Parent/Guardian Name: *Cell Phone
*Address: *City:
*State: *Zip Code
*Parents Email: *Emergency Contact Name:
*Emergency Contact Phone: 2nd Emergency Contact Name:
2nd Emergency Contact Phone:
Participant has no allergies, medical conditions, or physical restrictions, except for the following:
Please list all medications:

Liability Release: In consideration for being allowed to participate in the activities of the Zoe Family Ministries, Inc. camp, the undersigned and/or his or her parent or guardian (if under age 18) agree as follows: I agree to follow any rules, regulations and directions of Zoe Family Ministries, Inc camp directors, officials and/or teachers. I fully understand that by participating in the Zoe Family Ministries, Inc. activity or event, that there are inherent risks and dangers to which the participant may be exposed. These risks include the possibility of slight or severe bodily injury, sickness, disease or death or damage or destruction of personal property (including loss of use of property) caused by or arising from hazards including but not limited to slips or falls, insect or animal bites, water hazards, traffic or other travel accidents, or other damage to person, delay or inconvenience and or damage to property while participating in the Zoe Family Ministries, Inc. camp. I hereby give my consent for the participant, to be transported to and/or from the Zoe Family Ministries, Inc. camp in any type of vehicle and give my permission or consent for the participant to attend and participate in the Zoe Family Ministries, Inc. camp, including all activities, teachings, etc. By signing below, I waive all claims for damages, injuries and death sustained to the participant whether caused by the negligence of the released party or otherwise. I assume responsibility for any liability and all risk of harm or injury which may occur to the participant as a result of participating in the Zoe Family Ministries, Inc. camp event or activity. I hereby release Zoe Family Ministries, Inc. and all of its organizers, officers, directors, agents, employees, independent contractors, consultants, affiliates, subsidiaries, successors and assigns and anyone related to all events/activities from any liability, costs and damages resulting in participant's participation. I also give my consent for the Zoe Family Ministries, Inc. to seek emergency or other treatment for the participant, if necessary, and I agree to accept all financial responsibility for the costs related to this emergency or other treatment. I also give my consent/permission to use my image and likeness for any photographs and/or videos of the participant to be used for promotional purposes whether via websites or other promotional materials.

I have read this release of liability, indemnity and assumption of risk and fully understand its terms. I understand that I may have given up substantial rights by signing such, but sign freely and voluntarily without any inducement, assurance or guarantee and intend my signature to be a complete and unconditional release to the greatest extent allowed by law.

By typing your name below you understand this is a legal binding authorization. If you agree to these terms and liabilities, then please type your name below.


*Participants Signature: *Date (mm/dd/yyyy)
*Parent/Guardian Signature: *Date (mm/dd/yyyy):
Sponsor Name: Sponsor Phone:
Sponsor Email:
Comments:


***Applications must be received 4 days prior to camp dates.***