Church in Atlanta Bible Camp Registration and Medical Release Forms

Church in Atlanta 2026 Bible Camp Registration
When:  Wednesday, June 10 - Saturday, June 13, 2026; 10:00am - 2:00pm

Where:  District 4 meeting place (Black and Black warehouse; 5175 S Royal Atlanta Drive, Tucker, GA 30084)

Who can attend: Rising kindergarten through rising 6th grade. Youth (rising 7th through rising 12th grades) and parents are encouraged to register to serve.

Cost:  $100 per child; $20 per serving youth and parent (to cover cost of t-shirt)

Deadline to register: Friday, May 1, 2026
Registrant name*

First NameLast Name
MaleFemale
Registrant's t-shirt size*
Child to participateYP to serveMyself to serve

Child and YP Staff Registration
Parent/Guardian name*

First NameLast Name
Best phone number at which to contact you (the parent/guardian)*
Please enter a valid phone number.Format: (000) 000-0000.
Best email at which to contact you (the parent/guardian)*
example@example.com
Address (for delivering pre-camp packet)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registrant's grade this coming fall*
Registrant's birthday*

MonthDayYear
Date
Emergency contact name*

First NameLast Name
Emergency contact phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency contact relationship with registrant*
Physician's name*
Physician's phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Insurance company*
Insurance policy or group #*
Child allergies, medications, and other health concerns

Child and Youth Waivers and Releases
Medical Release and Liability Waiver
I, the parent or guardian of the above-named child (“participant”), hereby release, forever discharge, and agree to hold harmless the Church in Atlanta, its staff and volunteers; Black and Black Surgical, Inc., its owners, officers, agents, and/or employees; and other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (collectively, “Indemnitees”) 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 participant that occur while that participant is participating in the above described activity.

Furthermore, I assume all risk of personal injury, sickness, death, damage, and expense as a result of participation in transportation, recreation, and activities involved therein.

The undersigned further hereby agrees to hold harmless and indemnify the Indemnitees, their representatives, directors, employees, and agents, for any liability sustained by the Indemnitees as the result of the negligent, willful, or intentional acts of the participant, including any expenses incurred.

I further grant my permission for my child to participate fully in the above-described activity and hereby authorize the bearer of this document to obtain and direct any and all necessary first aid for my child, and, if my child needs emergency medical care beyond first aid, to obtain necessary medical assistance, including transportation, administration of medicines, surgical treatment, X-ray examination, or hospitalization as might be ordered by a licensed medical doctor. By signature hereto I hereby release and hold harmless the Indemnitees of any and all liability with respect to any medical care, medical decisions, treatment, or matters that may arise. I also accept full responsibility for the payment of any expenses incurred from such medical and/or emergency care.
Date*

MonthDayYear
Date
Signature*

Clear
Photo Release
I understand that from time to time activities during Bible Camp may be photographed or recorded. The Church in Atlanta will never publish a child’s name or any other personal information with any of its publications.
Do you give permission to The Church in Atlanta to use any photographs and/or videos of my child taken while participating in activities of the Bible Camp in the church’s digital and print communications (“publications”).*
Date*

MonthDayYear
Date
Signature*

Clear

Adult Staff Registration
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Singing/openingStory/lessonCraftActivities/gamesSnackPrizesRegistration / administrativePre-Bible Camp purchasingWherever needed / no preference

Adult Waivers and Releases
Liability Release
I do hereby release, forever discharge, and agree to hold harmless the Church in Atlanta, its staff and volunteers; Black and Black Surgical, Inc., its owners, officers, agents, and/or employees; and other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (collectively, “Indemnitees”) 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 while participating in the above-described activity.

Furthermore, I assume all risk or personal injury, sickness, death, damage, and expense as a result of participation in transportation, recreation, and activities involved therein.

The undersigned further hereby agrees to hold harmless and indemnify theIndemnitees, their representatives, directors, employees, and agents, for any liability sustained by the church as the result of the negligent, willful, or intentional acts of the undersigned, including any expenses incurred.
Date*

MonthDayYear
Date
Signature*

Clear
Photo Waiver
I understand that from time to time activities during Bible Camp may be photographed or recorded. The Church in Atlanta will never publish your name or any other personal information with any of its publications without your written permission.
Do you give permission to The Church in Atlanta to use any photographs and/or videos of you while participating in activities of the Bible Camp in the church’s digital and print communications (“publications”).*
Date*

MonthDayYear
Date
Signature*

Clear

Would you like to purchase *additional* t-shirts? ($15 per shirt). Enter the number desired, or leave blank.

Rows	Amount
Youth small
Youth medium
Youth large
Adult small
Adult medium
Adult large
Adult XL
Adult XXL
Adult XXXL

Please list any additional comments you may have here:

Discount code?
How much of the registration fee do you feel you can pay?*
use reg calc indicator
Checkout cost

Checkout

USDBible camp registration

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Click "Submit" to complete your registration.
Should be Empty:

Church in Atlanta 2026 Bible Camp Registration

Child and YP Staff Registration

Child and Youth Waivers and Releases

Medical Release and Liability Waiver

Photo Release

Adult Staff Registration

Adult Waivers and Releases

Liability Release

Photo Waiver

Click "Submit" to complete your registration.