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Camper's Information
First name:
Last name:
E-Mail Address:
Phone:
Date of Birth: *mm/dd/yyyy
Age:
Gender:
Male
Female
Street Address:
Apt #:
Street Address: *line 2
City:
State:
Zip Code:
Church Information
Church Name:
City:
State:
Zip Code:
Conference Waiver:
I assume any and all risks associated with this conference, including but not limited to accidents, the effects of weather, all acts of negligence on the participant part, staff or leadership, friends or peer group of participants and the act of third parties not under the control of Cambodian East Coast Youth Conference (CECYC) churches. Knowing this fact and in consideration of the acceptance of registration, I hereby, waive, release, indemnify, absolve and hold harmless the CECYC, its staff, employees, administrators, volunteers and other participants from any claim arising out of any injury to me. I further waive for myself, the right to sue any of the above specified parties for any injury to myself.
*** By submitting this form, you agree to the Conference Waiver ***