Ninja Warrior Camp 2018 Registration

Child Information
Name *
Name
Address *
Address
Birthday *
Birthday
List any special concerns that you feel CFA should know about your child. (i.e. Allergies, Medications, Medical Concerns, etc.)
Parent or Guardian Information
Parent or Guardians Name *
Parent or Guardians Name
Primary Phone Number *
Primary Phone Number
Secondary Phone Number
Secondary Phone Number
Emergency Contact Information
In the event of an emergency, the Parent/Guardian will be contacted before the Emergency Contact.
Emergency Contact *
Emergency Contact
Emergency Contact's Phone Number *
Emergency Contact's Phone Number
Acknowledge & Consent
Please read through the following information and type your name in the box below. In doing so, you attest that you are authorized to complete this form as the child's parent and/or guardian and that you acknowledge that you have read, understand, and consent to the terms and conditions below.
I, the undersigned parent and/or guardian do hereby grant permission for my child, named above, to attend Ninja Warrior Camp (“Camp”), a community outreach event of Cedarville First Assembly of God. In order that my child may receive the proper medical treatment in the event that he/she sustains or is perceived to have sustained injury or illness during Camp, I hereby authorize Cedarville First Assembly of God, its employees, agents, representatives, and any and all other persons (“Church Group”) to obtain or provide medical treatment for my child for such injury or illness. I hereby hold the Church Group and all event sponsors harmless in the exercise of this authority. I understand that there is always a possibility that my child may sustain physical illness or injury while at Camp. If this occurs, I hereby authorize the Church Group to refer my child to a medical treatment center (hospital, etc.). I acknowledge and understand that I will be responsible for any medical bill that may incurred on behalf of my child for physical illness or injury that he/she sustains or is perceived to have sustained during the Camp. Understanding that there is always a possibility that my child may sustain physical illness or injury, I acknowledge and understand that my child is assuming the risk of such physical illness or injury by his/her participation and I further release the Church Group and all event sponsors from any claims for personal illness or injury that my child may sustain during the Camp. I acknowledge and understand that my child will be responsible for his/her failure to abide by the rules and regulations of the Camp. I acknowledge and understand that while my child is on Cedarville First Assembly of God’s campus, property, or premises, photographs and/or videos will be taken of Camp attendees that may be used for publications and public relations activities by Cedarville First Assembly of God and/or sponsoring individuals/organizations. I give permission for photographs in which I and/or my child appear to be used for publications and public relations activities by Cedarville First Assembly of God and/or sponsoring individuals/organizations. I acknowledge that this may include use in print and electronic media, including the internet. *