(Mailing Address *if different)
(Mobile Number to receive texts:)
T-Shirt Size
*
Select Option
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult XXXL
Any special needs or circumstances we should know about (Allergies, dietary restrictions, medical conditions, hospitalizations, surgeries)?
Please upload a photo copy of your Medical Insurance Card (front and back):
Photograph/Social Media Release:
For purposes of crafts, promotion and ministry highlights, your photograph may be taken. Do we have your permission to use these photographs on the church website and social media?
If you do not have a roommate preference, leave these boxes blank.
We know the fine print is never fun, but please read the following sections very carefully. If you have any questions, please contact us prior to submitting your registration.
Media and Information Release
I do hereby consent to the recording, use, copyright, and publications of said camper's picture and/or recording by the Arkansas Baptist State Convention its successors and assigns, its clients and/or their advertising agencies of statements made by me, along with the use of my voice, name, picture, and/or likeness. (If camper is a minor, I certify I am the parent or legal guardian of said camper and provide this release.) I understand that such interviews, recordings, likenesses and/or pictures may be used in connection with the following project: Super Summer Arkansas.
I hereby waive any right to inspect and/or approve the finished product or advertising copy or recording that may be used in connection therewith. I release all claims of my own, and agree to indemnify against all claims of others arising out of the making or use of any film, tapes, photographs, or recordings of me.
The above described may be used by the Arkansas Baptist State Convention with no time limit.
I understand that by submitting this registration I consent to the use of said camper's contact information by the Arkansas Baptist State Convention and its agencies. This information is intended only for contact by the ABSC and its agencies in accordance with their purposes and will not be shared with any other individual or organization.
I hereby consent and give my permission to any authorized personnel to administer the necessary medication and/or medical treatment to my child (the above named individual) which may be deemed necessary or advisable in the event of injury, accident, and/or illness during his or her camp attendance. I also hereby consent and give my permission to any authorized personnel to take emergency measures deemed necessary for the care and protection of my child while under their supervision. In case of accident or illness, I understand that my child will be taken to an appropriate medical facility for treatment. It is understood that in severe situations, the adults in charge may contact the local emergency resource before the parent, child’s physician, and other adults acting on the parent’s behalf. I understand that any expenses incurred will be the responsibility of the child’s family.
Medication Administration
Information supplied in this policy includes, but is not limited to, medications that are to be administered by authorized personnel. Please note that each medication must be in the original container with the label still intact. All over-the-counter medications (OTC) such as Tylenol, Benadryl etc. must be in the original packaging with a pre-printed pharmacy label providing instructions on use.
I, the undersigned parent or guardian of the above named individual (or “my child”), acknowledge that attendance and participation in all camp-related activities at Super Summer Arkansas may involve the risk of physical injury. I knowingly and freely assume all such risks on behalf of my child and I willingly agree to comply with terms and conditions for my child’s attendance and participation. I agree that I will not make a claim against, sue, or prosecute Clinton First Baptist Church, Super Summer Arkansas, Arkansas Baptist State Convention, the Cooperative Program or Ouachita Baptist University, and/or their officers, directors, agents, sponsors and employees for damages for death, personal injury, which my child may sustain as a result of his/her attendance and participation at Super Summer Arkansas. Knowing that there are inherent risks or dangers, I certify that my child is fully capable of attending and participating in the activities Super Summer Arkansas has to offer.
I, as a parent/guardian with legal responsibility for my child, do consent and agree to his/her release as provided above and for myself, my heirs, assigns, and next of kin. I release and agree to indemnify and hold harmless Clinton First Baptist Church, Super Summer Arkansas, Arkansas Baptist State Convention, the Cooperative Program or Ouachita Baptist University from any and all liability incidents to my child’s involvement or participation at Super Summer Arkansas as provided above, to the fullest extent permitted by law. I have carefully read this consent and release of liability and fully understand and agreed to its contents.
Applies to Chaperones as well.No refunds will be given for any registration and you will be charged the FULL registration fee of $265.