5 Day Club at Shiloh Hills Fellowship
July 29-August 2, 10AM-11:30AM | Thanks for joining us for the 5 day club! Please fill out this form and click submit.
Parent Name
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Phone
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Address
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Email
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This address will receive a confirmation email
Emergency Contact
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Emergency Contact Phone
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Child 1 Name
*
Child 1 Birthday
*
Child 1 Allergies
Child 2 Name
Child 2 Birthday
Child 2 Allergies
Child 3 Name
Child 3 Birthday
Child 3 Allergies
Child 4 Name
Child 4 Birthday
Child 4 Allergies
I recognize that there are risks involved in participating in this activity and hereby assume all risk of injury, harm, damage, or death in connection with my participation in this activity. I understand and agree that neither Shiloh Hills Fellowship nor its trustees, officers, directors, employees, agents or representatives may be held liable in any way for any injury, harm, damage, or death that may occur to me as a result of my participation in this activity and hereby release Shiloh Hills Fellowship, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death, which may occur while I am participating in the activity. To the fullest extent permitted by law, I agree to save and hold harmless Shiloh Hills Fellowship, its trustees, officers, directors, employees, agents and representatives from any claim by myself, my estate, heirs, successors, assigns or other persons arising out of my participation in the activity. I authorize Shiloh Hills Fellowship through its trustees, officers, directors, employees, agents or representatives to render or obtain such emergency medical care or treatment for me as may be necessary should any injury, harm or accident occur to me while participating in this activity. I understand and acknowledge that Shiloh Hills Fellowship, does not provide health or medical insurance in connection with the activity and I agree that I will be financially responsible for any bills incurred as a result of medical treatment, including emergency medical treatment and/or transportation to a medical facility, in connection with my participation in the activity.
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Please select all that apply.
yes
I understand that Shiloh Hills Fellowship may, from time to time, document the activities of the ministry with photos or videos. I hereby assign and grant to SHF and assign the unqualified right to the ownership, use and proceeds of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational and promotional purposes
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Please select all that apply.
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Description
July 29-August 2, 10AM-11:30AM
Thanks for joining us for the 5 day club! Please fill out this form and click submit.
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