Camp Ta-Ku-La
READ CAREFULLY AND SIGN: I hereby request that my child (or I being 21 years or age or older) be accepted to attend Camp Ta-Ku- La. I understand and am aware that my child (or I) will be participating daily in many physical activities and that the potential for accidents and or exposure to pathogens does exist. I hereby give my permission for my child (or myself) to ride in camp buses and vehicles. Furthermore, I authorize the camp to furnish food, lodging and transportation to my child (or myself.) As further consideration for the acceptance of my child (or myself) to attend Camp Ta-Ku-La, I, individually, or on behalf of my child, hereby release, discharge, indemnify and hold Camp Ta-Ku-La and the sponsoring church or organization and respective directors, officers, employees, agents and representatives (the Released Parties) from any and all liability and any and all claims or demands for loss or damage on account of injury, illness or death to a person or property, and any and all costs and expenses, including without limitation attorney’s fees, whether caused in whole or in part by the negligence of the Released Parties or any of them, as a direct or indirect result of my child’s (or my) attendance at Camp Ta-Ku-La, and I, individually, and on behalf of my child (or myself) hereby waive any and all claims and causes of action against the Released Parties or any of them, resulting directly or indirectly from my child’s (or my) attendance at Camp Ta-Ku-La.
PARENTS AUTHORIZATION TO PROVIDE NECESSARY TREATMENT: I hereby give permission to the medical personnel selected by the camp director and/or staff to order X-rays, routine tests, treatment, to release any and all records necessary for insurance purposes, and to provide or arrange related transportation for me or my child. In the event I cannot be reached in an emergency, I hereby give my permission to the physician selected by the camp director and/or staff to secure and administer treatment including emergency treatment, surgery or hospitalization, for the person named above. I assume the responsibility of all medical bills and ancillary incurred expenses. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I hereby assume all transportation costs.
Activities: I give my child permission to participate in all activities (zip-line, climbing tower, human foosball, cage dodge ball, and gun range)
Camp Ta-Ku-La has my permission to use photographs and videos of my child named above taken during camp for promotional purposes. No first and last names will be published without permission.
I have read and understand the foregoing terms and conditions, including without limitations the release provision, and by my signature knowingly agree to each and every term and condition as stated above.
Fellowship Baptist Church
The undersigned grant permission to Fellowship Baptist Church representatives to take and use: photographs and/or digital images of the above named child for use in news releases and/or promotional materials as follows: printed publications or materials, electronic publications, flyers, posters, church promotional slides, or websites. I agree that my child’s name and identity may be revealed in descriptive text or commentary in connection with the image(s). The undersigned authorize the use of these images without compensation. All negatives, prints, and digital reproductions shall be the property of Fellowship Baptist Church.
The undersigned grant permission for the above named child to attend and participate in the activities at Fellowship Baptist Church between the dates of January 1, 2026 and December 31, 2026.
The undersigned authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of an physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical treatment pursuant to this authorization.
The undersigned will not seek to have Fellowship Baptist Church held liable in the event that any accident, injury, loss of property or any other circumstance or incident occurs during or as a result of the above named child’s participation in the church sponsored event. This release of liability includes accident, injury, loss, or damages to the child, as well as to other individuals or property, which may result from the child’s participation in the event. The undersigned hereby release and agree to hold harmless Fellowship Baptist Church, its ministers, officials, volunteers, agents and employees, from any claims arising out of the child’s participation in the event(s).
Should it be necessary for the above named child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. The undersigned does also hereby give permission for the above named child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by Fellowship Baptist Church.
By sigining belows you are confirming that you are the parent or guardian of the child/children listed above, that the information you have provided is to the best of your knowledge and accurate, and that you agree to the terms listed throughout this document.