Waiver & Medical Release Form
Lakeshore Camp

Wednesday, August 7th - 4:30pm-10:00pm

Chaperones: The Embassy Student Leadership Team

Cost: $10 (includes bus) Transportation: Bus

Please fill out ONE FORM per child.

I/We, the parents or guardians named above, authorize the ministry staff of The Embassy of the Kingdom of God church to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participants named above.

I/We, named above, undertake and agree to indemnify and hold blameless the ministry staff, The Embassy of the Kingdom of God church, its pastors and Board of Elders from and against any loss, damage or injury suffered by the participant(s) as a result of being part of the activities of The Embassy of the Kingdom of God church, as well as of any medical treatment authorized by supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to events of The Embassy of the Kingdom of God church.
The Embassy of the Kingdom of God church is collecting and retaining this personal information for the purpose of enrolling your child(ren) in our programs, to assign the student(s) to the appropriate classes, to develop and nurture ongoing relationships with you and your child(ren), and to inform you of programs updates and upcoming opportunities at our church. This information will be maintained permanently as it is a requirement of the insurance company and legal counsel. If you wish The Embassy of the Kingdom of God to limit the information collected, or to view your child’s information, please contact us.


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