_________________________________ _______________________________
Camper Name Parent/Guardian
Name (please print)
Day
Basketball/ Session I, June 13-17 ___ One
Child $30/week
Soccer/ Session I, June 20-24 ___ Two
Children $55/week
Flag Football, June 27-July 1 ___ Three or More $80/week
Basketball/ Session II, July 11-15 ___ Discounts:
Soccer/Session II, July 18-22 ___ 2-peat (2sessions) $55/child
3-pack (1 of each) $80/child
5-pack
(ALL) $125/child
Waiver, Consent for Medical Treatment & Photo
Release
As the parent or legal guardian of the
above-named player, I hereby give my consent for emergency medical care
prescribed by a daily licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever
conditions are necessary to preserve life, limb or well-being of my dependent.
X
______________________________________________
Signature of Parent/ Legal Guardian
It is understood that every precaution
will be taken for the safety and well-being of me or my child, but in the event
of accident, sickness, or serious injury, Skybacher Ministries, its staff and
its volunteers are hereby released from any liability. I understand
participation in the day camp is voluntary, and am
entering into these activities of my own free will and desire, and therefore
accept all risk and responsibility associated therewith. As a parent or guardian of a minor child, I
agree to waive all claims including those for medical and related expenses
arising out of injuries incurred by said minor.
As a parent or guardian, I also accept
responsibility for any and all damage to person or property resulting from
improper conduct by said minor.
I also give permission for Skybacher
Ministries’ staff to use or to reproduce and distribute any photos taken of me
or my child at any of the above events for purposes to further Skybacher
Ministries and broaden its impact in the community.
I understand, and acknowledge I have
read this agreement. I also acknowledge
that I have the opportunity to ask staff for explanation to any questions I
have regarding this agreement. I acknowledge
that am signing this voluntarily and am bound by the contents contained herein.
X
______________________________________________
Signature of Parent/ Legal Guardian
Skybacher
Ministries, Inc.
John
& Kristie Mohrbacher
724.846.1776
www.skybacherministries.org