This is an online registration form and should only be filled out by parents, guardians or individuals 18 years or older. None of the information gathered will be shared with outside parties. By completing, you agree that all information you provide is accurate.

 

Under the provisions of the Volunteer Immunity Act, I agree to hold harmless Every Kid Outreach, Inc., (EKO), its’ staff, volunteers, and private providers (i.e. The Life Center Church, Mears Transportation and Younglife at Southwind). This immunity will also include travel.

 

 

I authorize EKO, its’ staff, and volunteers to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to my child under the general or special supervision and on the advice of any physician or dentist licensed under the provision of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

 

 

I am aware that the total cost of the weekend camp (after receiving $100 EKO sponsorship) is $150, which includes includes transportation, food and lodging. I give permission for my child and or listed youth to be interviewed, photographed, videotaped or used for any pictorial representation for EKO purposes.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

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