Embassy – Intense

Student's Form

When: Sunday, Nov 19 - Monday, Nov 20

Start and End Time: 12:30 PM, Nov 19 - 2:00 PM, Nov 20

Who: Embassy Students

Start & End: Believers World Outreach Church 1600 Woods Road Brookshire, TX 77423

Lake Livingston State Park: 300 State Park Rd 65, Livingston, TX 77351

Price: $25 per student (includes transportation, food, and accommodations)

How many Children are You Signing Up?

Parent's First Name

Parent's Last Name

Email Address

Child's First Name

Child's Last Name

Child's Birthday

Does your child have any Allergies?

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Emergency Contact Relationship to Child

Child #2

Parent's First Name

Parent's Last Name

Email Address

Child's First Name

Child's Last Name

Child's Birthday

Does Your Child Have Any Allergies?

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Emergency Contact Relationship to Child

Child #3

Parent's First Name

Parent's Last Name

Email Address

Child's First Name

Child's Last Name

Child's Birthday

Does Your Child Have Any Allergies?

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Emergency Contact Relationship to Child

Assumption of Risk: Participants assume all responsibility for Participants’ own safety while participating in the Pro- gram. Participants understand that the Program may involve participation in activities which are physically demanding and could involve possible hazards, not all of which can be foreseen, including but not limited to property damage, injury, or death resulting from falling, sickness, inclement weather, cuts, abrasions, wounds, broken bones, injury from contact withother partic- ipants of the Program or sporting and athletic equipment, muscle strains or sprains, concussion, drowning, heart attack, or exposure to poisonous plants, insect bites, animals, and sun exposure. Participants further understand that participation in the Program is completely voluntary, and Participants assume the risk of any and all property damage, injuries, or death that may occur to Participants as a result of participation in the Program. Safety: Participants will wear required clothing and safety equipment, as appropriate to each activity of the Program, and bring and apply sunscreen and insect repellent as necessary. Participants will not leave the authorized areas at any time without permission and will follow all safety in- structions and use caution to protect themselves, other participants, BMI personnel, and others. Participants agree to cooperate with leaders, fellow participants, and BMI personnel. Fitness to Participate in Program: Participants certify that except as noted specifically in the BWOC Volunteer Application Form, they are completely physically, mentally, psychologically, and emotionally fit and healthy, and capable of participating in the Program and all activities. Participants are solely responsible for determining whether there is any reason they should not participate in the Program or any activities, including possible contact with any substances that may cause any allergic reactions. Lost or Stolen Items: Participants acknowledge and understand they are responsible for the security of their own belongings while participating in the Program and are advised not to carry valuable items with them for the dura- tion of the Program, including but not limited to: large amounts of cash, credit cards, laptops, mobile phones, tablets, or other electronics, and family heirlooms or expensive jewelry. Participants acknowl- edge that Burchfield Ministries International,Inc., Country Camp, Inc., and Texas Bible Institute, Inc. are not responsible for securing Participants’ belongings. Medical Treatment: Participants consent to receive emergency medical treatment in the event of illness or injury and release and forever discharge BMI from any liability or claim whatsoever which arises or may later arise on account of any medical services rendered in connec- tion with an emergency during Participants’ participation in the Program. Photo and Media Release: Participants grant to BMI all right, title, and interest in any and all photographs, images, video, or audio recordings of Participants or Participants’ likeness or voice made by BMI in connec- tion with the Program. Participants understand and agree that they will not receive compen- sation for any use of such material. Participants expressly agree that BMI shall have the right to photograph, publish, re-publish, adapt, exhibit, reproduce, edit, distribute, display, or oth- erwise use or reuse the Participants’ image and/or likeness in connection with any product or service in all markets, media, or technology, including in promotional and advertising material for the Program. Waiver and Release: Participants release and forever discharge and hold harmless Burchfield Min- istries International, Inc., and each of their directors, officers, employees, agents, related entities, and representatives (collectively, “BMI”) from any and all liability, claims, and demands of any kind or nature, either in law or in eq- uity, which arise now or in the future in connection with Participants’ partic- ipation in the Program. Participants understand and agree that this Release discharges Discovery Camp from any liability or claim that Participants may have against BMI with respect to bodily injury, personal injury, illness, death, or property damage that may result from Participants’ participation in the Pro- gram. Participants expressly waive any right to a trial by judge or jury that Participants may otherwise have with regard to any claim or liability related to Participants’ participation in the Program. Broad Release Intended: Participants expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Texas and that this Release shall be governed by and interpreted in accordance with the laws of the State of Texas. Participants further agree that in the event any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected. Indemnity: In consideration of and for the right to participate in the Program, Participants ex- pressly agree to indemnify and hold harmless BMI from any and all claims, liability, actions, causes of action, debts, claims and demands of any kind or nature, either in law or in equity, which arise now or in the future in connection with Participants’ participation in the Program, including but not limited to bodily injury, personal in- jury, illness, death, or property damage that may result from Participants’ participation in the Program.

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Donation Amount:

$ 25.00

Donation Summary
Payment Amount
Giving Frequency	One time
Donation Total

Embassy Intense

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