2023 Southcliff Registration/Medical/Liabilty Release Form for Student Ministry Summer Camp

Student Information


Parent/Guardian Information

*I (parent/guardian listed above) give permission for the above named minor to join Student Ministry of Southcliff Baptist Church to attend Summer Camp at Highland Lakes on Monday, June 12- Friday, June 16. The group will be traveling by Charter Bus.

Emergency Contact Information

Emergency Contact information must be different than parent/guardian listed above. Will only contact in case of emergency when we can not reach the parent/guardian.


Important Information

*I (the named parent or guardian) hereby release Southcliff BC, its staff and sponsors, from responsibility and liability for any injury or illness that my child may sustain during this activity, as agent for me, to consent to any X-ray examination; medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor's office or in any hospital. I expect to be contacted as soon as possible.

*I release Southcliff Baptist Church, its members, officers, agents, employees, and workers from any expenses that might occur in relation to any above mentioned injuries and illnesses.

*I agree to be responsible for any damages or other expenses incurred by my student's action.

*I commit to pay the cost of camp and realize that payments are non-refundable.

*If the camp leadership deems it necessary, I will promptly travel to camp to pick up my student at my own expense.

*Upon receipt of the deposit and Southcliff Online Registration Form, you will receive, via email, a code to register online with Highland Lake Camp. You MUST register with Highland Lake to reserve your spot at camp.