Step 1-Complete the Form Below for Each Young Person

Step 2-Submit Online Payment for Each Young Person You are Registering.

ex: $10 for 1 person, $20 for 2 persons, $30 for 3 persons, etc.

Home Phone
Work Phone
Home Phone
Work Phone

Medical Info

Medical Information and/or Restrictions (e.g. allergies, carries inhaler, etc.) If there are none, entered NONE in this section.

Granting Permission

I believe that South Seaville Camp Meeting Association (SSCMA) is providing adequate supervision for this event, but I understand that participation of my child at this event is at my own risk. I consent to participation of my child and authorize the SSCMA Board of Directors or their designee/volunteers to take whatever reasonable steps (s)he deems necessary in order to provide emergency medical care for my child. I further agree to permit my child to be transported to a medical facility by ambulance or other commercial vehicle. I understand and agree that I will be responsible for all medical bills and costs that may be incurred as a result of medical care and treatment of my child.

Digital Signature Information: For your convenience you may now E-sign this document by checking the box below and typing your name on the signature line above. If you do not wish to use E-sign, simply print form, sign & print your name and send by email address above. Your typed E-signature along with the symbol /s/ is considered legal under the Federal E-Sign Act. Aer you check the box, click submit.
Click or drag a file to this area to upload.
If you wish you may print this form, sign it and upload it to us.