I understand and certify that my child’s participation in St. Paul’s Presbyterian Church’s (SPPC) Day Camp program held at the church and its activities is completely voluntary. I recognize that certain hazards and dangers are inherent in Day Camp events and programs and I acknowledge that although SPPC has taken safety measures to minimize the risk of injury, SPPC cannot insure nor guarantee that the participants’, equipment, premises and/or activities will be free of hazards, accidents, and/or injuries. I further recognize and have instructed my child in the importance of knowing and abiding by SPPC’s rules, regulations and procedures for the safety of participants. I waive any claim against SPPC and/or its personnel for any lost articles; for any injury to my minor child; and/or any injury to myself. 

INSURANCE COVERAGE: SPPC assumes secondary insurance coverage. I assume primary coverage.

This health history is correct so far as I know, and the person named on this form has permission to engage in all camp activities except as noted. 

AUTHORIZATION FOR TREATMENT: In case of emergency, I understand that every effort will be made to contact the parent(s) or guardian(s) of the Day Camper. In the event I cannot be reached, I hereby give permission to the medical personnel selected by the church to order x-rays, routine tests, treatment, and necessary transportation for my child. I give permission to the physician selected by the church to secure and administer treatment, including hospitalization, for my child as named on this form. 

AUTHORIZATION FOR USING LIKENESS: I hereby give permission for photographs/ video including my child and/or myself to be used in the promotion of the ministries of SPPC. 

COMPLIANCE WITH ELECTRONICS POLICY: I understand that SPPC does not allow any electronic devices except cameras, and I certify that I have ensured my child’s compliance with this policy.