Finish Line Summer Camp 2022 Registration Please fill out the form to Register for Summer Camp 2022. Please enable JavaScript in your browser to complete this form. Camper’s InfoFirstLastAddressCityState ZipBirthdateMM/DD/YYYYGrade Entering in Fall 2022SchoolGenderMaleFemaleT-shirt size YOUTHYOUTH SYOUTH MYOUTH LT-shirt size ADULTADULT SADULT MADULT LADULT XLPlease list any other information you would like to include about your camper.Parent/Guardian 1 Information FirstLastHome Phone NumberCell Phone NumberEmailParent/Guardian 2 InformationFirstLastHome Phone NumberCell Phone NumberEmailEmergency Contact InformationFirstLastRelationshipHome Phone NumberCell Phone NumberPlease list names of authorized pick-ups (18 years old and older)FirstLastPlease list names of authorized pick-ups (18 years old and older)FirstLastDoes the Camper have any allergies, chronic illness, or medical conditions? If yes, please describe?Please select the week(s) your camper will be attending Finish Line Summer CampWeek 1 June 13 – June 17Week 2 June 20 – June 24Week 3 June 27 – July 1<b> No camp on Monday July 4th</b>Week 4 July 5 – July 8Week 5 July 11 – July 15Week 6 July 18 – July 22Week 7 July 25 – July 29Week 8 August 1 – August 5Week 9 August 8 – August 12FAITH LANDMARKS MINISTRIES RELEASE AND HOLD HARMLESS INDEMNIFICATION AGREEMENTI understand and agree with the following terms and conditions pertaining to the Faith Landmarks Ministries sponsored – Finish Line Summer Camp June 13, 2021 – August 12, 2021As evidenced by my signature below, as the participant (or parent/guardian if participant is a minor), I acknowledge that I will be participating in this activity (Finish Line Summer Camp) on my own volition and at my own risk. I hereby agree to release FLM from any and all liability, damages (direct, indirect and/or special), claims, or losses that might arise out of any loss, alteration, or destruction of personal property which I may have with me during this activity. This includes but is not limited to luggage, purses, briefcases, money, and jewelry.I (or parent/guardian if participant is a minor) agree to hold FLM harmless from any liability, damages (direct, indirect and/or special), claims, or losses that might arise as a result of injury, sickness, disease, or death suffered by me during this activity (Finish Line Summer Camp), including but not limited to any expenses incurred for medical treatment.I (or parent/guardian if participant is a minor) further understand that I will indemnify and forever hold and save FLM harmless from any expenses related to injury to another person or property damage caused by me or connected with my conduct in any way, including, but is not limited to, attorney’s fees.I (or parent/guardian if participant is a minor) acknowledge that FLM does not have any insurance, including, but not limited to, insurance for health, workers compensation, disability, and/or life benefits that would cover my participation in this trip. I have my own insurance coverage or will assume full responsibility for any health claim.I will obey the rules and regulations as prepared by FLM and distributed to me as a participant, (which may be subject to change) in order to manage the safety and well-being of all participants involved in this activity (Finish Line Summer Camp). Photographs, videos, etc. may be taken during this event. These could be used at later dates for website, event promotions, shown during services, etc. Do you approve of you or your child’s image being photographed or videotaped during this event? YesNoSignature of Parent/Guardian | Confirmation | BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. *Submit
