Family Camp Registration Leave this field blank Full Name (Guardian 1) Full Name (Guardian 2) Cell Phone Home Phone Email Confirm Please re-enter your email to confirm. Please enter the name and age of each child attending Family Camp. Name Age Name Age Name Age Name Age Dietary restrictions Please list dietary restrictions or special needs, or type “None.” Number of beds needed: 1 bed2 beds3 beds4 beds Please tell us how you will travel to Family Camp: We will take the train.We will drive.We will drive and can help take families to and from the train station on Friday and/or Sunday.We will drive and cannot take families at this time. MANDATORY RELEASE AGREEMENT I. ACTIVITY The activity named above has been described to me and I understand the nature of the activity and the risks associated therewith. I hereby agree fully to assume any and all risks of my family’s participation therein. II. ILLNESS In the event of illness or accident where I am unable to make my own medical decisions, I authorize a licensed physician to evaluate me. Please contact the person named below: Emergency Contact Name Emergency Contact Phone If the person named above cannot be reached after every reasonable effort has been made, I authorize that any immediately necessary treatment be given. Please list any allergies, and describe any other important medical details: If you do not have any allergies or important medical details, please type "none." III. RELEASE I hereby release and hold harmless Fifth Avenue Presbyterian Church, its officers, agents (including, without limitation, those leading the activity named above) and employees from and against any and all liabilities, claims, damages and other charges of whatever nature which may be incurred by, imposed on, or asserted by me or on my behalf in connection with the above-referenced activity. I also agree to have our photos taken on the retreat and give FAPC permission to post these photos on fapc.org and in the church's social media. IV. SEPARATION Should any clause, or any part thereof, contained in this release and permission agreement be invalid and/or unenforceable for any reason, such clause or part thereof, as the case may be, shall be construed to effect the nearest intent thereof and shall not affect the validity or enforceability of this agreement or of any other clause hereof. Acknowledgment I ACKNOWLEDGE and AGREE to the above statements of ACTIVITY, ILLNESS, RELEASE and SEPARATION.I DO NOT AGREE to the above statements of ACTIVITY, ILLNESS, RELEASE and SEPARATION and will NOT be attending. COMPLETING YOUR REGISTRATION After you click the submit button, you will receive acknowledgment and a confirmation email. The email will include additional details about the weekend. Submit