1conic Academy & Calvary Camp

1CONIC ACADEMY & CALVARY WORSHIP CENTER CAMP PERMISSION FORM 2025.

Please carefully review the information regarding your child’s attendance in the 1conic Academy & Calvary Worship Camp for the following session(s):

SESSION 1 - FEBRUARY 18th
SESSION 2 - FEBRUARY 19th
SESSION 3 - FEBRUARY 20th

We want to ensure a safe and fun environment for all children attending camp. By acknowledging and granting your permission in the following areas, we will be on our way to creating an exciting, memorable experience.

A waiver will need to be signed for all players prior to their participation in the camp. You can complete the online waiver below. If preferred, waivers can be printed and given to David Jamina and Jacob LeSane prior to the camp or on the day of Session 1. There will be printed waivers on site.

Please email [email protected] with any questions. In the weeks before the program, more information will be provided about camp expectations, attire, and specific details.

Child Name *

Child DOB *

Address

Street Address *

City *

State *

Country *

Postal code *

Emergency Contact *

Phone *

Additional Emergency Contact (Optional)

Allergies (If Applicable)

MEDICAL INSURANCE CARRIER/POLICY NUMBER:

HEALTH RECORD: I acknowledge that our child is in good health and her/his immunizations are current. Any health restrictions, allergies, medications taken by the child, or any other needs, are noted below:

Check all that apply:

My child carries an Epi-pen.

My child carries an inhaler.

My child will have medication with them.

List Medication:

Additional Health Record Comments

CONSENT & SIGNATURE *

Photo Consent: I give permission for 1conic Academy and Roots to take photographs and audio/video recordings of my child and family. 1conic Academy and Roots may publish, distribute, or otherwise use the photos in professional manners that 1conic Academy and Roots believes is proper for Center-related purposes only. The use of these photos/recordings is limited to: print publications to be distributed to 1conic Academy player families (i.e. newsletters or postings in the building), classroom photos, and photos/videos on the 1conic Academy webpage or social media.

Should it be necessary for my child/me to have medical treatment while participating on a trip, I hereby give the staff & volunteers permission to use their judgment in obtaining medical services, and I give permission to the physician selected to render medical treatment deemed necessary and appropriate by the physician. I understand that 1conic Academy has no insurance covering medical or hospital costs incurred and, therefore, any cost incurred for such treatment shall be my sole responsibility.

All persons attending 1conic Academy’s & Calvary Worship Center’s Camp are deemed to have waived all claims against 1conic Academy and its staff & volunteers for injury, accident, illness, or death occurring during or by reason of the camp. I have read and understand the foregoing statement and agree to assume the responsibility stated and waive all claims.

Parent/Legal Gaurdian Name: *

Signature *

Clear

Collect Payment *

$ 100

By checking this box, I consent to receive messages related to my purchase, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Email will be our primary form of contact.

Tap Here For Waiver Form (Print Only)

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Payment

100% Satisfaction Guarantee!

If you are not completely SATISFIED and ENLIGHTENED by the Program, then contact us within 10 Days for a full refund, no questions asked!

What People Are Saying:

"This program has helped me with my speed of play, my confidence and getting into the flow state easier."

- Edrian Bautista