The following information is needed so that KMBC can run a background check. Sensitive information will not be shared with unnecessary parties.
Medical Questionnaire
Parent/Legal Guardian Consent
I, the undersigned parent/guardian, hereby consent to my child participating in the New Heights Youth Camp, an event sponsored by Kentucky Mountain Bible College, meeting multiple weeks in the summer. I consent to allow my child to be photographed or recorded during the event for public relations by KMBC and it's employees. I certify that my child is able to participate in the camp activities as listed in the brochure and otherwise. I understand that NHYC is an active camp and may not be suitable for individuals with physical limitations and or emotional/behavioral special needs. I understand that if my child falls into this category that they must be accompanied by a parent or chaperone. If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them. In the event of an emergency, I may be reached at the telephone numbers listed above. If I cannot be contacted, I hereby authorize Kentucky Mountain Bible College, its agents or employees to obtain such medical treatment as may be necessary in their judgment to ensure health, safety and well-being of my child. I understand and hereby agree to assume all risks which may be encountered on said activity, including activities preliminary and subsequent there to. I hereby agree to hold Kentucky Mountain Bible College, their agents and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child, property even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities. I expressly agree that this release, waiver and indemnity agreement is intended to be broad and inclusive as permitted by law of the State of Kentucky and that if any portion thereof is held invalid; it is agreed the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and a mere recital. I will disclose and update any changes that may occur to this release before the date of the event. I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understood.
I understand that participation in youth camp activities involves inherent risks, including but not limited to potential exposure to COVID-19, and I accept full responsibility for these risks and release Kentucky Mountain Bible College, its employees, and affiliated parties from liability. In case of an emergency, I hereby authorize Kentucky Mountain Bible College, its agents or employees to obtain such medical treatment as may be necessary in their judgment to ensure health, safety and well-being. I understand and hereby agree to assume all risks which may be encountered on said activity, including activities preliminary and subsequent there to. I hereby agree to hold Kentucky Mountain Bible College, their agents and employees harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to me or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities. I understand the risks involved with COVID-19 exposure and otherwise with group camp activities, and incidents related to COVID-19 are expressly included as part of this waiver. I expressly agree that this release, waiver and indemnity agreement is intended to be broad and inclusive as permitted by law of the State of Kentucky and that if any portion thereof is held invalid; it is agreed the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and a mere recital. I will disclose and update any changes that may occur to this release before the date of the event. I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understood.