Timberlake Students: High School Winter Camp 2027

Registration type

$419.00

Student

FREE

Leader (if interested contact kaiha.p@timberlake.church)

Prices are in USD.

Who’s this registration for?

First name

Last name

Email address

Student Information

Fill this information out for the *STUDENT* that will be joining us at camp!

Mailing Address

Apartment Number

City

Zipcode

Campus you usually attend

Grade

Gender

Student You'd Like to Room With (First and Last Name!!)

Anything else we should know? (food allergies, medical needs, etc.)

Parent/Guardian Info

Fill this information out for the *PARENT/GUARDIAN* responsible for the student joining us at camp!

(Leaders please enter emergency contact information.)

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian E-mail address

Insurance Information

Physician's Name

Physician's Phone Number

Insurance Policy/Group #

Insurance Company

Timberlake Waiver

The above student has my permission, as parent/guardian, to attend this function with Timberlake Church. I agree that Timberlake and/or its leaders are not liable for any accident related to either the planned event or transportation to or from that event. Nor are they liable for any injuries sustained or any lost, stolen, or damaged articles. I also agree that my child will be responsible to Timberlake Church and its leaders for all of his/her actions on this event. I authorize Timberlake and any adult leader to obtain the services of a physician and/or hospital for the care of my child, if necessary, including emergency medical care, emergency x-rays, and/or emergency surgery. Should the need arise, I also authorize Timberlake Church and its leaders to incur any necessary expenses for such services in the event of accident or illness, and I agree to provide payment for those expenses.

I agree to these terms