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Student Camp 2024

HHBC Waiver



Photo/Video Release: By submitting this registration and by my participation in this Henderson Hills Baptist Church (HHBC) activity, I hereby give my permission and consent, now and for all time, to HHBC to make, reproduce, edit broadcast, or rebroadcast any video footage, sound recordings, or photo reproductions of my child for publication, display, or exhibition thereof in promotions, advertising and legitimate uses without any compensation to, and/or claims by me. My child may, or may not be identified in such reproductions. Completing this registration indicates that I have read, understand, and consent to the above photo/video release.  

I Agree

Medical Release: As the participant, parent, and/or guardian (if under 18 years of age) of said member I hereby consent and give my permission to Henderson Hills Baptist Church, its representatives, or any medical provider, to make such decisions, to perform diagnostic testing and medical treatment, which may in their sole discretion be necessary and proper under the circumstances. Treatment may include over-the-counter medications such as Tylenol, Ibuprofen, Allergy medicine, Pepto Bismol, etc... As the participant, parent, and/or guardian of said member, I hereby do release, acquit, discharge to hold harmless Henderson Hills Baptist Church or its representatives or any attending physician, from any and all actions, damages, or liabilities arising out of the treatment of any sickness or accident incurred by above-said participant during time-away while on any church activities.

I Agree

No Tolerance Policy: HHBC has a No Tolerance policy that includes verbal or non-verbal harassment, sexual misconduct, threatening behavior, intimidation, and bullying. Any child that jeopardizes the safety and care of another person will be sent home.

I Agree

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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