Camper Name *

First Name

Last Name

Gender *

Male

Female

Parent Phone *

(###)

###

####

Medical and Liability Release *

I consent for my child to attend and participate in Youth Camp at Indian Springs. In the event of any illness, injury, or accident I will not hold any camp staff, counselor, or First Love Ministries responsible. I give my permission for necessary medical treatment to be administered in the event of an emergency.

By checking this box, I give my electronic signature

Date of Signature *

MM

DD

YYYY