WINTER RAMP

Student Name *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

Student Mobile Phone Number *

(###)

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Parent/Guardians Name *

First Name

Last Name

Parent/Guardians Mobile Phone Number *

(###)

###

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Parents/Guardians Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

ACKNOWLEDGMENT OF RISK AND WAIVER OF LIABILITY *

I, the undersigned, wish to voluntarily participate in The Ramp Youth Camp. In consideration for being permitted to participate in the The Ramp Youth Camp, in the city of Hamilton, Alabama beginning the 26th day of June, 2025, I, the undersigned, fully recognizing the dangers and hazards inherent in The Ramp Youth Camp and any related transportation, including personal injury, property damage, or wrongful death, as well as the unknown dangers and hazards which may arise in the course of my participation in The Ramp Youth Camp, do hereby voluntarily: Agree, for myself, my heirs and my personal representative, to defend, hold harmless, indemnify, release and forever discharge, to the broadest extent allowed by law, Life Church Family, its trustees, officers, employees, agents, insurers, successors, assigns, from and against any and all claims, demands, actions, or causes of action on account of any damage to real or personal property or any personal injury or death that may result from my participation in above The Ramp Youth Camp. I have read this release, I understand it fully, I understand that it is legally binding, and I understand that, among other things, I am agreeing to indemnify Life Church Family. , for injuries, damages or losses I may cause and giving up rights to sue Life Church Family for injuries, damages or losses I may incur.

CLICK TO SIGN (this serves as your legal signature)

PARENT/GUARDIAN CONSENT TO MEDICAL, DENTAL, OR HOSPITAL CARE *

I consent to any x -ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care under the general or special supervision and upon the advice of or to be rendered by a physician and surgeon licensed under the Medical Practice Act for my child. This authority also extends to any x-ray examination, anesthetic, dental, or surgical diagnosis or treatment and hospital care by a dentist licensed under the Dental Practice Act for my child. I further agree to pay all charges for the dental, medical, or hospital care or treatment. As parent or legal guardian of my child, I am responsible for the health care decisions of my child and am authorized to consent to the services to be rendered. I represent that my consent to and agreement to pay for the dental, medical, or hospital care or treatment to be rendered to my child is legally sufficient and that no consent from any other person is required by law.

Checking this box serves as my legal signature

Does this child have any allergies *

Yes (if yes, list them in the text box below)

No

Does this child have to take medication? If so, list it below. *

Yes

No