Mega Sports Camp Registration Form



Child's Name:*
Parent/Guardian Name:*
Address:*
Home Phone:
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Work Phone:
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Cell Phone:*
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Email:*
Child's Date of Birth:*
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 / 
Gender:
Last Grade Completed:
Sports Choice:*
Medical or other information we need to know. (Please include any food allergies):
Primary Emergency Contact (other than listed above):*
Phone:*
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Secondary Emergency Contact (other than listed above):
Phone
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Signature of Parent or Guardian:*

Wellspring Church International 

Liability Release Form

In consideration for being accepted by Wellspring Church International, Richmond, Texas, for participation in Mega Sports Camp Fall 2019 on October 26. I/we, the undersigned and the participant, do hereby release, forever discharge, and agree to hold harmless Wellspring Church International and the elders thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property, that occur while said person is participating in the above-described trip or activity including recreation and work activities. The undersigned further hereby agrees to hold harmless and indemnify said Church, its elders, employees, and agents for any liability sustained by said acts of said participant including expenses incurred attendant thereto. 

The undersigned further consents to the administration of first-aide and / or doctor’s care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the described, the undersigned agrees to hold harmless and indemnify said Wellspring Church International, its elders, employees, and agents from any acts of malfeasance, and / or failure to act on the part of those chosen to administer medical care on behalf of the participant. 

***By signing up to participate in the fall 2019 Mega Sports Activities, you agree that any photos taken could possibly be used on our website and/or on our Facebook page.

Pictures are only to be taken by Wellspring Church International Staff. Only take pictures of your own child.***

Sign Date:*
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 / 
Participant:*
Parent/Guardian:*
Home Number:*
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Emergency Number:*
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Participant’s Insurance Company
Policy Number
Conference Coordinator*