Escape Room Summer Camp Registration

Parent First Name *

Parent Last Name *

Phone *

Email *

Postal code *

NAME & DATE OF BIRTH OF EACH CHILD ATTENDING CAMP

Child #1 Name *

Child #1 Birthdate *

Child #2 Name

Child #2 Birthdate

Child #3 Name

Child #3 Birthdate

Additional Children and Birthdates

Authorized Adults for Pick Up (First and Last Name) *

Emergency Contacts (Please provide two) *

Children are required to bring their own snacks and a lunch. Does your child have any allergies we need to be aware of?

Any other medical concerns or issues we should be aware of?

Acknowledgment of Risk
I, the undersigned, acknowledge that participation in the activities offered by Apogee Denton involves inherent risks that may result in physical injury, illness, property damage, or other unforeseen consequences. I understand and accept these risks.

Medical Treatment Authorization
In the event of an emergency, I authorize the group leaders, volunteers, or appointed chaperones to obtain medical treatment for my child(ren) if I cannot be reached. I understand and agree that I will be responsible for any medical expenses incurred due to such treatment.

Release of Liability
In consideration for allowing my child(ren) to participate in field trips and activities offered by Apogee Denton, its officers, directors, employees, volunteers, and any other participants, I, on behalf of myself and my child(ren), hereby release and discharge Apogee Denton, its volunteers, its contractors (including but not limited to drivers and coaches), and Journey Fellowship Church (as the property owner and host site of the camp), from any and all claims, liabilities, lawsuits, or causes of action arising from any injury, illness, or damage that may occur during any field trips, activities, or transportation to and from said events, whether caused by negligence or otherwise.

By signing below, I acknowledge that I have read and understood the above waiver and consent form and agree to be bound by its terms.

Signature *

Clear

Congratulations! We are so excited to have you at camp! After hitting the submit button below you will be redirected to Stipe for payment. Please adjust the quantity if enrolling more than one child*.

If you would like to pay by check you may do so by contacting us at [email protected] to let us know and can simply close out the credit card payment site.

*There is a sibling discount of 50% that I cannot currently modify the Stripe payment processor to reflect. If you are enrolling more than one child in your household (and do not want to pay by check) simply pay for one and send us an email at [email protected] to request a 50% of link for the remaining children.

Thank you and sorry for this inconvenience!