YCL - Legacy Church GA

2017 Legacy Youth Camp Leader Form

* Indicates required field

Leader Name *

First

Last

Leader Email *

Leader Phone Number *

Adult T-Shirt Size *

Gender *

Male Female

Date Of Birth *

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Insurance Company Name *

Insurance ID# *

Additional Concerns (allergies, medications, medical conditions, etc) *

By submitting this form you are agreeing to the following (you may be asked to also sign a hard-copy):
I the parent/guardian, do hereby grant permission for my son/daughter, named above, to attend this event sponsored by Town Center Community Church / Legacy Church (TCCC/LC). Event Transport (if applicable): I give permission for my child to be transported to and from activities at TCCC/LC and other off-site functions in the church bus or other authorized vehicles driven by qualified, approved, and insured drivers. Medical care: In order that my child may receive the proper medical treatment in the event that he/she may sustain injury or illness, I hereby authorize the staff and authorized volunteers to provide basic medical care to my child (band aids, OTC medications as directed by parent/guardian) or to allow them to transport and obtain care from a medical facility. And I hereby agree to hold harmless the staff of, TCCC/LC, GA Fellowship of the Church of God, Volunteers, sponsors, and the event facilities in the exercise of this authority. I further understand that I will be responsible for any medical bills that may be incurred on behalf of my son/daughter for physical illness or injury. Photo Release: I understand that photos of the event, activities, and of my child may be taken, and I assign copyright to TCCC/LC and agree that such photographs may be used for any lawful purposes including publicity, illustration, advertising, and social media content.

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2017 Legacy Youth Camp Leader Form