NOTE: Parent and teen must sign this form.
My child will be attending the Believer’s Boot Camp sponsored by The Door CFM, Jacksonville N.C.
I hereby authorize the camp or appointed health personnel to examine, treat or administer medications for any illness or injury to my child: to order x-rays, routine tests and treatment from a licensed, certified or authorized health care provider; and to seek emergency medical treatment as deemed necessary.
The health history submitted is correct to the best of my knowledge and the above named individual may engage in all camp activities. I understand that as in any other physical activity or sport my child may be exposed to above normal risks. I furthermore release, indemnify, and hold harmless the Camp Monroe, The Door CFM, its partners, the individual partners and their spouses, the partnership’s employees and agents from and against any and all sickness, injury, claims, liabilities, or damages suffered from any act or omission of the camp Monroe, its agents and employees and/or such above mentioned health care providers. I accept responsibility for payment of expenses incurred as a result of medical treatment. I understand and accept that in the event of any personal injury incurred by my child during this week retreat, we will forfeit all fees paid.
My child agrees to abide by the terms and conditions stated in the camp information sheet. My child agrees to comply with the rules of the camp. If he/she chooses to disregard the rules or behave in a way that may cause injury to others or self, he/she will be sent home from the camp immediately and without refund of fees paid.
I and my child have read and understand the above statements and will comply with the rules of the camp.
For inquiries, email us at
bootcamp@thedoorjnc.comDokime boot camp official (910) 382-7062. *Camp Phone (FOR EMERGENCY USE ONLY) (910) 382-7062
