Name *

First Name

Last Name

Birth date *

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DD

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Agreements

Please check the agreements and sign below

Criminal Background Check Authorization: I hereby authorize Pioneer Bible Camp to obtain and/or request information about my criminal history through a background check. The background check authorization will be sent to your email.

Release Agreement: I understand that Camp Insurance is for minor injuries up to $3500 and that my personal insurance is the primary coverage. While every effort is made for safety, I recognize that there are risks connected with some activities, including but not limited to, gym activities, sledding, group games, etc. I therefore agree to assume, as an explicit condition of my participation, any and all risks. I agree to hold harmless Pioneer Bible Camp and Fellowship Bible Church and its associates from any and all liability, claims, demands and causes of action whatsoever which may arise due to my participation.

Date Signed

MM

DD

YYYY