I, the undersigned parent/guardian, do hereby grant permission for my son(s)/daughter(s), named above, to attend this Day Camp at University Drive Alliance Church. In order that my child(ren) may receive the proper medical treatment in the event that he/she may sustain injury or illness during this Day Camp, I hereby authorize the camp staff to obtain or provide medical treatment for my child for such injury or illness during the camp, and I hereby hold the camp staff and sponsoring organization(s), as well as its representatives, harmless in the exercise of this authority. I further understand that there is always a possibility that my child(ren) may sustain physical illness or injury while at the camp. If this occurs, I hereby authorize the camp staff and representatives to refer my child(ren) to a medical treatment center (hospital, etc.) I further acknowledge and 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 that he/she may sustain during the camp. Understanding that there is always a possibility that my child(ren) may sustain physical illness or injury, I acknowledge and understand that my child(ren) is assuming the risk of such physical illness or injury by his/her participation, and I further release the sponsoring organization and its representatives from any claims for personal illness or injury that my child(ren) may sustain during the camp. I further acknowledge and understand that my child(ren) will be responsible for his/her failure to abide by the rules and regulations of the camp. I also consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of my child during the event to be used, distributed or show, for promotional purposes, as University Drive Alliance Church sees fit.

Please note that we have a family cost limit of $90 so please choose your payment amount accordingly. You can choose a single payment but you must fill out an application form for each child. For consecutive children, please select : "This is a child in the same family as one who already paid" option.