2026 CHBC Youth Camp: Registration

CHBC Youth Camp 2026
Waiver & Release Form

All participants in Carpenter's House Baptist Church and CHBC Youth Ministries must have a signed Waiver & Release Form, including adults 18 years and older. Participants under 18 must have the authorized signature of a Parent/Guardian. It must be brought to registration.

Name of Church: Carpenter’s House Baptist Church

City/State/Zip: Germantown, OH 45327

* Indicates required field

Camp *

Participants Name *

First

Last

Birthdate: *

Age: *

Sex: *

Male Female

Address: *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Legal Guardian Name: *

First

Last

Parent/Legal Guardian Phone Number *

Student's Phone Number: *

Email: *

School: *

Grade Going Into: *

Church: *

Shirt Size: *

Please check which one best describes the attendee (more than one may apply): *

Student Adult Youth/Children's Minister

Consideration. I acknowledge the personal benefits accruing to me (and my child, as applicable) by reason of participation in the above described event and am aware of the activities in which I, or my child, will be involved through said participation.

Release / Indemnification. I hereby, in consideration of such benefits and other good and valuable consideration received, consent to the above listed participation and release absolutely, forever discharge, hold harmless and covenant not to sue Carpenter’s House Baptist Church and CHBC Student Ministry, its directors, employees, agents, volunteers, and affiliates from any and all present or future liability, claims, demands, actions or rights of action, whether asserted by me or a third party arising out of my (or my child's) participation in event activities (the "Claims"). I agree to indemnify and hold harmless Carpenter’s House Baptist Church and CHBC Student Ministry for any such Claims brought by me or a third party from any costs associated with defending or litigating such claims, including but not limited to attorney fees, costs and legal expenses.

Assumption of Risk. I am aware of the risks associated with participation in the above event and do hereby voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including death, that may result from participation in event activities.

Medical Emergency. In the event of injury or a medical emergency, I understand that the church’s group leader will be responsible for the medical care of all attendees. It will be the church group leader's responsibility to assess medical needs, obtain and consent to appropriate medical care, transport persons in need of medical care and contact parents or guardians of minors. In addition, I assume the risk and financial responsibility for any injury resulting from the attendee’s participation in all Carpenter’s House Baptist Church and CHBC Student Ministry events.

Understanding. I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein, and I signed voluntarily as my free act and deed, that I have had an ample opportunity to obtain the advice of counsel and that, by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be construed as broadly and inclusively as is permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect. To the extent the restriction on filing lawsuits is deemed unlawful, I agree to submit any Claims to a Christian conciliation/mediation organization for binding resolution.

Media Consent. I give my consent and permission for the taking of photographs and/or video of me (or my child) during the described event and waive and/or assign any and all rights (including copyright) in such media to Carpenter’s House Baptist Church & CHBC Student Ministries.

CAUTION: READ THIS DOCUMENT CAREFULLY BEFORE SIGNING.
THIS IS A GENERAL RELEASE AND INDEMNIFICATION OF CLAIMS.

Please check, which applies: *

Parent/Legal Guardian Attendee 18 years of age and older

Electronic Signature: *

First

Last

Relationship to Participant: *

Contact Number: *

Registration & Release Form for CHBC Youth Camp 2026
Health Record and Consent for Treatment

1. Does the student have any known physical defect or illness which might interfere with his/her participation in strenuous activity? If so, please explain. *

2. Please list any allergies, drug reactions, medications or other pertinent medical information: *

3. Is the student presently taking any medication? Does the student adhere to any special diet or exercise restrictions? If yes, please list specific details (names of drugs, dosage, etc.) *

4. Indicate that the following are current - TTB (Tetanus, Dip Tox, Booster shot): *

Yes No

Please Note: The following non-prescription medications will be available for your child if needed. Permission is necessary in order for medication to be administered. If you DO NOT wish for your child to have any of the following medications, please check mark them below: *

Insurance Information:

Insurance Policy Name: *

First

Last

Insurance Provider *

Insurance Policy Number: *

Release/Indemnification: I, the undersigned adult/parent/guardian, do hereby grant permission for myself, my son/daughter, named previously, to attend all Carpenter’s House Baptist Church and CHBC Student Ministries trips, events and activities for 2026-2027. In order that I or my son/daughter may receive the proper medical treatment if I/he/she sustains injury or illness, I hereby authorize the leaders to obtain and/or provide medical treatment for myself, my son/daughter for such injury or illness during these trips/events, and I hereby hold Carpenter’s House Baptist Church, CHBC Student Ministries, and the leaders, harmless in the exercise of this authority.
I further understand that there is always a possibility that I, my son/daughter may sustain physical illness or injury while attending this trip/event. If this should occur, I hereby authorize Carpenter’s House Baptist Church and CHBC Student Ministries trips staff/counselors/leaders to refer me, my son/daughter for treatment at a medical treatment center, and/or hospital, etc. I further acknowledge and understand that I will be responsible for any and all financial cost associated with physical illness or injury that may be incurred on behalf of myself, my son/daughter during these trips/events.
Understanding that there is always a possibility that I, my son/daughter may sustain illness or injury, I acknowledge and understand that I, my son/daughter am/is assuming the risk of such physical illness or injury by my, his/her participation. I further release and hold harmless the Carpenter’s House Baptist Church, CHBC Student Ministries, and all staff/leaders from liability for any and all claims of personal illness or injury in these trips/events. I further acknowledge and understand that I, my son/daughter will be responsible for my, his/her failure to abide by the rules and regulations of these trips/events.

Please check, which applies: *

Parent/Legal Guardian Attendee 18 years of age and older

Electronic Signature *

First

Last

Date: *

Payment for CHBC Youth Camp 2026

The cost per student is $100. Payment must be received by June 3rd. If payment is made after this date, please contact Pastor Skyler Duncan at (513) 292-8111 to confirm availability.

This deadline helps us ensure your student has a reserved spot for The Ark Encounter and allows us to accurately plan for meals and supplies.

Payments may be made by mail or dropped off at the church during designated office hours or service times. Our church address is:
Carpenter’s House Baptist Church
93 Worthington Dr.
Germantown, OH 45327

We accept both cash and check. If paying by check, please make it payable to Carpenter’s House Baptist Church.

Please clearly mark the student’s name with all payments, whether cash or check, so we can properly credit the registration.

Please type "I Understand" *

Submit

CHBC Youth Camp 2026Waiver & Release Form

All participants in Carpenter's House Baptist Church and CHBC Youth Ministries must have a signed Waiver & Release Form, including adults 18 years and older. Participants under 18 must have the authorized signature of a Parent/Guardian. It must be brought to registration.

CAUTION: READ THIS DOCUMENT CAREFULLY BEFORE SIGNING.THIS IS A GENERAL RELEASE AND INDEMNIFICATION OF CLAIMS.

Registration & Release Form for CHBC Youth Camp 2026Health Record and Consent for Treatment

Insurance Information:

Payment for CHBC Youth Camp 2026

CHBC Youth Camp 2026
Waiver & Release Form

CAUTION: READ THIS DOCUMENT CAREFULLY BEFORE SIGNING.
THIS IS A GENERAL RELEASE AND INDEMNIFICATION OF CLAIMS.

Registration & Release Form for CHBC Youth Camp 2026
Health Record and Consent for Treatment