Individual Registration Form

Late registrations are subject to a $10 procrastinator’s fee.

After completing the form below for each participant, please follow the link to pay your registration fees.

Which Camp Are You Applying For

Group Name (If applicable)

Type of Registration

Name

First Name

Last Name

Birthday

YYYY

Last Grade Completed

Sex

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Parent/Legal Guardian Name

In Case Of Emergency Notify

Relationship

Emergency Phone

(###)

###

####

Email Address

High School Grad?

Medical Information and Liability Release Form

List any diseases, physical or mental limitations

Medications Currently Taking and Purpose

Allergies (Food, Medical, Insects, etc)

Restricted Activities

Family Physician

Family Physician Phone Number

(###)

###

####

Family Medical Insurance

Policy Number

Please Read And Sign the Disclosure Below

In consideration for being accepted by ZBM for participation in Zachary Bigley Ministries, Plugged-In Youth Camp, Graduate event or Transformed Kid’s Camps, we (I), as the Parent or Legal Guardian, being 21 years of age or older, do for ourselves (myself) (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless Zachary Bigley Ministries, Inc and the directors thereof from any liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant that occur while said child is participation in above described trip or activity. Furthermore, we (I) (and on behalf of our (my) child-participant if under the age of 21 years) hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in recreation and work activities involved therein. I also give permission to Zachary Bigley Ministries to use any media for purpose of camp or ministry promotion or other ministry purposes. Further, authorization and permission is hereby given to said ministry to furnish any necessary transportation, food and lodging for this participant. The undersigned further hereby agree to hold harmless and indemnify said Zachary Bigley Ministries, INC, its directors, employees and agents, for any liability sustained by said ministry as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto. We (I) are parent(s) or legal guardian(s) of this participant, and hereby grant our (my) participant, and hereby grant our (my) permission for him (her) to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including, but not in limitation, participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable arbitration process. All Deposits are non-refundable. This registration is confirmation that you have read and accept this policy. This form must be completely filled out to qualify for acceptance into any of the Zachary Bigley Ministries, Inc Camps or events. I also understand if a discipline problem should arise, that I give the authority to those in charge of the activity/camp to discipline my son/daughter. If a discipline problem should occur that cannot be handled by those in charge, I will be notified & asked to personally pick up my son/ daughter from this activity. I also understand that there will be no refund of fees if my son/daughter/child is removed from the activity/camp and that I will provide any necessary expense in removing my child from the activity/camp. If medical attention is needed for my son/daughter, I give the participating volunteers or the Staff member in charge, permission to administer minor first aid and/or deliver my child to a medical facility for medical attention. After reasonable effort is made to secure my permission or if my permission is secured, I hereby give the physician, selected by the volunteer or staff member in charge of the activity, permission to hospitalize and to administer whatever medical attention that is needed to maintain the proper health and safety of my Son/Daughter. I, as parent/guardian, hereby release Zachary Bigley Ministries, INC and/or their staff, any other party connected with Plugged-In Youth Camp, Transformed Kid’s Camp and any facilities from fault for any injury to my child, which may occur during the activity/camp, including any Covid-19 or any variants that may occur while at any ZBM events.

First Name

Last Name

Date Read and Signed

YYYY

By signing I agree with all the information & that it is true and accurate:

Cart (0)