June 19 – 23, 2017
Registration Form For Kidz Entering Grades 1-6
Jefferson United Methodist Church
125 East Jefferson St. Jefferson, OH

By submiting the form your are agreeing to the Participation Agreement below:

Price of $25.00 per child includes T-shirt, lunch and classes. Kamp
begins at 8:45 am and ends at 2:15 PM. Contact Jeannie Hoffman at
440-576-4561 for more information.

NOTES: Checks should be made to Jefferson UMC and dropped off at the office or mailed to 125 East Jefferson St, Jefferson, OH 44047. Please not your childs name in the memo.
DEADLINE for registration: Wednesday June 14, 2017
Kamp is limited to the first 100 participants to register


Participation Agreement
In consideration for the opportunity to participate in the activity described above (the “Activity”), the Participant (or
parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation
in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial
responsibility for any injury sustained during the Activity or during transportation to and from the Activity, as well
as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees,
volunteers, or any other representatives (collectively referred to hereinafter as the” Sponsor”). Further, the
Participant (or parent/guardian) releases and promises to indemnify, defend and hold harmless the Activity Sponsor
for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity,
whether such injury arises out of the negligence of the Sponsor, or the Participant, or otherwise.
If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to
resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or
parent/guardian) and the Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member
arbitration panel of the American Arbitration Association for final resolution.