ManUp Camp Registration Camper Full Name*Age*Contact Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AllergiesMedicationsHobbies & InterestsWhat are you most looking forward to at camp?Contact Person*Contact Person Phone Number*Contact Person Email* Waiver of Liability In checking this authorization, I acknowledge that I am aware that the activities associated with this event entail certain inherent risks including damage to property, personal injury and emotional stress. In consideration for being permitted to participate in this event, I agree to assume all such risks and hereby release and discharge Camp Zion, Feeding the Orphans and the landowner (O’Leary family) from any and all liability for any and all damage, loss, injury, or death of every kind and nature whatsoever which in any way arises out of my participation in this event. Permission to Treat in an Emergency I hereby give permission to the chaperone to provide routine health care, administer prescription drugs, and seek emergency medical treatment including ordering X-rays and/or routine tests. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the chaperone to hospitalize, secure proper treatment, and to order injection and/or anesthesia and/or surgery for me/or my child as named in this form. Permission to Travel I give permission for me/my child to be transported in a private vehicle if necessary. Paintball Waiver and Release of Liability In consideration of Camp Zion furnishing services and/or equipment to enable me to participate in Paintball games, I agree to the following: I fully understand and acknowledge that; (a) risks and danger exist in my use of Paintball equipment and participation of Paintball activities; (b) my participation in such activities and/or use of such equipment may result in my injury or illness including but not limited to body injury, disease, strains, fractures, partial and/or total paralysis, eye injury, blindness, heat stroke, heat attack, death or other ailments that could cause serious disability; © these risks and dangers may be caused by the negligence of the owners, employees, officers or agents of Camp Zion, the negligence of the participants, the negligence of others, accidents, breeches of contract, the forces of nature or other causes; and (d) by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages, wether caused in whole or part by negligence or other conduct of the owners, agents, officers, employees of Camp Zion; or any other person. I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify Camp Zion and it’s owners, agents, officers and employees from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of service or otherwise which may arise out of my use of Paintball equipment or my participation in Paintball activities. I specifically understand that I am releasing, discharging and waiving any claims or actions that I may have presently or in the future for negligent acts or other conduct by the owners, agents, officers or employees of Camp Zion. I have read the above waiver and release and by signing it agree it is my intention to exempt and relieve Camp Zion and the O’Leary landowners from liability for personal injury, property damage or wrongful death caused by negligence or any other cause. Photo Release I hereby grant the Feeding the Orphans permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.I understand and agree that all photos will become the property of the Feeding the Orphans and will not be returned.I hereby irrevocably authorize Feeding the Orphans to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.I hereby hold harmless, release, and forever discharge Feeding the Orphans from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.I have read and understand the above photo release. I affirm that I am at least 18 years of age, or, if I am under 18 years of age, I have obtained the required consent of my parent/guardian as evidenced by their signature below. Electronic Signature*Date Are you receiving a scholarship to attend camp?*YesNoManUp Registration Fee Price: $125.00 Total $0.00 Credit Card* DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.