M*A*S*H Week 2017
Mastering A Servant's Heart
July 10 - 14, 2017
8:30 AM - 1:00 PM
Entering 6th - 8th Grades
$40 registration includes a t-shirt, lunch each day and service project supplies.
Student's Grade Fall 2017
Student's Cell Phone
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
T-Shirt Size (adult sizes)
Parent/Guardian Cell Phone
Enter the primary email address for contacting about this event.
As a parent, I would you like to volunteer to pick up lunches.
As a parent, I would you like to volunteer to drive?
Will your student participate all five days?
Check the days the student will participate.
LIABILITY RELEASE & PARENTAL CONSENT FORM
In consideration for being accepted by THE CHAPEL ON THE CAMPUS and THE CHAPEL IN THE OAKS for participation in this special event activity, I being 18 years of age or older, do for myself do hereby release, forever discharge and agree to hold harmless and indemnify The chapel on the Campus and its directors, officers, employees, agents, and anyone else for whom it may be held liable from any and all liability, claims or demands (including attorney fees, defense costs, expenses, court costs, etc.) 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 child-particpant that occur while said child is participating in the above described trip or activity.
Furthermore, I hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in transportation, recreation and work activites involved therein, recognizing the inherent risks and dangers involved in participation in this activity.
Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food, lodging, and medical treatment, including, but not limited to, emergency surgery or medical treatment, and the responiblity for all such expenses incurred is hereby assumed by the participant, and/or his/her parent or legal guardian.
I further hereby agrees to hold harmless and indemnify said church, its directors, officers, employees, agents, and anyone else for whom it may be held liable for any liability sustained by said church as the result of the negligent, willful or intentioal acts of said participant, including attory fees, defennse costs, expenses, court costs, etc. incurred attendant thereto. I, the parent or legal guardian of this participant, and hereby grant my permission to this participant to a doctor or hospital and 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 any physician or dientist, whether such diagnosis or treatment is rendered at the office of said physician or at a hospital and assume the responsibility for all medical bills incurred, if any.
Further, should it be necessary for the participant to return home due to medical reasons, disciplinary actoion or otherwise, I hereby assume all transportation costs.
Any modification of this form is null, void, and without legal effect.
LIABILITY RELEASE & PARENTAL CONSENT
I have read and agree to the above Liability Release and Consent Form
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