REGISTRATION PACKET
2015
This packet includes the following:
INTRODUCTION LETTER
THE KALEO TEAM
DATES & CAMPUS INFORMATION
PRICING DETAILS
THE MUST READ LIST
REGISTRATION/ORIENTATION PROCEDURE
RULES
TENTATIVE SCHEDULE/PACKING LIST
CONTACT PERSON FORM
STUDENT & ADULT REGISTRATION FORM
MEDICAL RELEASE FORM
HLGU WAIVER
ROOMMATE PREFERENCE FORMS
Missouri Baptist Convention • 400 East High Street • Jefferson City, MO 65101 • 800.736.6227
A ministry made possible through the Cooperative Program.
Dear Youth Leader,
Thank you for your interest in Super Summer 2015. We are
very excited that you have chosen to be a part of what we
expect to be a GREAT WEEK! Enclosed you should find
everything you need to register for Super Summer. Please read
through all of the contents carefully. This will help make the
registration process as smooth as possible.
Super Summer is designed for students who have COMPLETED 7th-12th grades. Please
tell your 6th grade students that we will look forward to having them next year and we
apologize for any inconvenience this may cause.
Super Summer is designed to help students grow in their faith in Christ and to equip
them in building relationships and sharing their faith. But we welcome any students that you
bring prepared for this experience – regardless of where they are in their journey with Christ.
Super Summer will be a great place for students to understand what a relationship with
Christ is all about. Your students will be sitting under the teaching of some incredible
leaders during the week of Super Summer, both during the team times and during the
evening worship times.
We expect the maturity necessary to participate in Super Summer in accordance
with the rules you will find in this packet. Please make sure you communicate these to your
students clearly and know that we will be depending upon you to see that this happens.
Super Summer is going to be a fun opportunity for your students. However, our greatest
purpose is to help them grow deeper in a relationship with Jesus Christ!
Please make note of the reduced cost for any adult leadership to attend the
ENGAGE leadership development training. We are very excited about the opportunity to
have youth pastors and lay leaders together for a time to be encouraged, receive training
and resources, and connect with other youth pastors and lay leaders from all over Missouri.
Thank you again for making plans to be with us at Super Summer. We look forward to
seeing you there and are expecting God to do great things in the lives of our students.
Please pray with us to that end!
…because of Jesus…
Matt Kearns & the LDT
Questions?
Contact Jeff Carson at
[email protected]
or
573-636-0400 ext. 327
Missouri Baptist Convention • 400 East High Street • Jefferson City, MO 65101 • 800.736.6227
A ministry made possible through the Cooperative Program.
THE KALEO TEAM
SUPER SUMMER 2015
Over the course of the last 3 years we have seen 200+ students identify a specific "call to
ministry" at some point during Super Summer. This is both exciting and telling, and begs for a
next-step response from the Leadership Development Team (LDT) as we seek to "deploy and
develop followers of Jesus for the Kingdom movement."
The Kaleo Team at Super Summer 2015 is one of those next steps. Kaleo, a Greek word
meaning "to call, to invite", will be a week-long experience that coincides with the age-graded
team schedule. Student candidates for Kaleo will:




Identify a specific "call to ministry".
Have completed 9th grade.
Submit a unique camp application along with 2 recommendations.
Focus their teaching/learning time on material and experiences related to ministry
calling, equipping, and practice.
As you can see, we are requiring Kaleo Team candidates to submit an application along
with 2 recommendations. One of these recommendations must come from a church leader,
preferably a youth leader. The student may choose any other person to provide their 2nd
recommendation, as long as that person takes the process seriously. Please note that
application for the Kaleo Team does not guarantee placement on the Kaleo Team. Should a
student not be placed on the Kaleo Team, he/she will be placed on the corresponding team
according to his/her last grade completed.
All Kaleo Team candidates are required to complete and send in the Registration Form,
Medical Release Form, HLGU Waiver, and deposit like all other students. Contact Jeff Carson
([email protected]) to receive a link to the Application.
ALL KALEO TEAM APPLICATIONS AND REFERENCES MUST BE RECEIVED BY MAY 15, 2015.
All camp rules provided in this information packet apply equally to those on the Kaleo
Team. Just like the Red, Blue, Orange, Yellow, Green, and Silver teams, students on the Kaleo
Team will be housed in dorms, participate in large group worship gatherings, and eat meals
with all the other students.
As a youth leader or church ministry leader, we are VERY DEPENDENT upon your
recommendation. The Kaleo experience will not be designed for everyone and we urge you
to encourage any candidates to take this opportunity and application seriously. Our hope is
that this experience will fan into flame the desire to serve in ministry that your child/student has
expressed! We believe in the next generation and desire to do all we can to deploy and
develop followers of Jesus for the Kingdom movement!
Questions?
Contact Jeff Carson at
[email protected]
or
573-636-0400 ext. 327
DATES & CAMPUS INFORMATION
SUPER SUMMER 2015
Dates:
Campus Address:
Campus Phone:
Directions:
Telephone:
Week 1 – June 8-12, 2015
at
Hannibal-LaGrange University
2800 Palmyra Road
Hannibal, MO 63401
Week 2 – June 15-19, 2015
at
Hannibal-LaGrange University
2800 Palmyra Road
Hannibal, MO 63401
(573) 221-3675
(573) 221-3675
For directions, please contact the campus directly or MapQuest® directions using
the above address.
Super Summer requests that calls be limited to emergency calls only. Should the
students need to contact family members on a daily basis, each dormitory is
equipped with phones for the students to use. However, incoming calls to Super
Summer need to be limited to emergencies only. An emergency would include
severe family illness or death. Calls about travel arrangements, etc., should be
unnecessary. All arrangements need to be taken care of prior to Super Summer.
In case of emergency during the week of Super Summer, call:
Matt Kearns (573) 680-7432 – or –
Jeff Carson (573) 645-1563
Housing:
All Super Summer participants will be housed in on-campus dormitories at each
week of camp. Adults will be housed with other adults and students with other
students as much as possible. Adults, do not plan on coed housing. Room
assignments will be made on a first come/first served basis with individuals within
church groups assigned as close together as space permits. PLEASE DO NOT ASK
FOR SPECIAL HOUSING CONSIDERATIONS unless there is a health problem. If you
did not include a note with your registration explaining your need, please contact
the Super Summer office right away at (800) 736-6227, ext 327.
Accessibility:
Please understand that participation in Super Summer will involve a moderate
level of physical activity, including quite a bit of walking. If there are any questions
about accessibility, please contact the Super Summer office at (800) 736-6227,
ext. 327.
Meals:
Meals will begin with supper on Monday night and will conclude with breakfast on
Friday morning. Lunch on Friday will not be provided by Super Summer. If you or
your students have food allergies or are on a strict diet as prescribed by a
physician, please contact us, and we will do our best to accommodate your
needs.
PRICING DETAILS
SUPER SUMMER 2015
Here is a breakdown of Super Summer 2015 pricing:
•
Early Bird Registration Rate – $199/student
o Forms & Deposit postmarked on/before May 4th.
o $75 nonrefundable deposit for each student/adult registering required.
•
Regular Registration Rate – $225/student
o Forms & Deposit postmarked May 5th through May 26th.
o $75 nonrefundable deposit for each student/adult registering required.
•
Late Registration Rate – $249/student
o Forms & Deposit must be in the LDT office by 4:00 p.m. June 1st.
o $75 nonrefundable deposit for each student/adult registering required.
•
Adult/Leader Rate – $150/adult
o Forms & Deposit must be in the LDT office by 4:00 p.m. June 1st.
Here is a visual breakdown of the pricing:
Tuesday
Monday
Sunday
MAY 2015
Wednesday
Friday
Thursday
Saturday
4/27
4/28
4/29
4/30
1
2
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
6/2
6/3
6/4
6/5
6/6
4/26
3
31
Postmarked
on/before today
6/1
Forms/deposit
in our office
by 4:00p.m.
Postmarked
on/before today
Color Key
Early Bird: $199.00/student
Regular: $225.00/student
Late: $249.00/student
No Registrations Accepted
THE MUST READ LIST
SUPER SUMMER 2015
•
REGISTRATION DEADLINES (Please reference the deadlines on the previous page.)
We anticipate an increased attendance at Super Summer 2015. As a result, we will only
be able to accept the first 400 student/adult registrations for each week. The only way to
secure spots for you and your group is to send in your Registration Forms and Deposits.
No registrations will be accepted after 4:00 p.m. on June 1, 2015. This means that forms
postmarked on June 1st will not arrive in our office by the deadline and will not be added
to the registration list. It is your responsibility to ensure that all Registration/Medical
Release Forms, HLGU Waivers and deposits make it to our office at/before that time.
•
PAYMENT
Deposit payments may be made by credit/debit card, check, or cash – but please do
not send cash in the mail! Visit www.mosupersummer.com for the link to the credit/debit
card payment site. All checks are to be made payable to the Missouri Baptist
Convention, and deposit checks should be sent to the address listed on the Registration
Form. The remainder of your balance (paid with check or cash) should be brought with
you to Super Summer.
•
CONTACT PERSON FORM
Only one Contact Person Form needs to be submitted for each church group that is
attending Super Summer. The Contact Person, in most cases, is the youth leader who will
accompany the students to Super Summer.
•
REGISTRATION FORMS
Every student and leader (anyone who is attending Super Summer) must complete a
Registration Form, Medical Release Form, and HLGU Waiver. Incomplete forms will not be
accepted.
o DO NOT send in Medical Release Forms without a Date of last tetanus shot.
“Current” and “don’t know” are not acceptable answers.
o
•
DO NOT send in Medical Release Forms without the requested insurance
information. Students and adults are not required to have medical insurance to
attend Super Summer. If a student or adult does not have insurance, please check
“No” on the bottom portion of the Medical Release Form.
ROOMMATE PREFERENCE FORMS
All students and adults from your group must be listed on the Roommate Preference
Form. If a particular student or adult has no rooming preference, please write “No
Preference” after his/her name on the Roommate Preference Form.
REGISTRATION/ORIENTATION PROCEDURE
SUPER SUMMER 2015
Registration will take place in Roland Fine Arts Center on the Hannibal-LaGrange University
campus. Small group leaders will be serving as greeters at each campus entrance.
REGISTRATION:
The Contact Person (or representative) will come to the central registration table to pick up
their group’s registration packet and pay the balance for their church group. The Contact
Person (or representative) should have a copy of their final attendance list as well as all
medications in hand (all meds to be turned in to Super Summer Nurse). Materials, t-shirts, and
lanyards will be given out at the registration table. After picking up the group’s registration
packet, the Contact Person will then proceed to the room key table (also located in Roland
Fine Arts Center) to pick up room keys from the HLGU Resident Directors.
CANCELLATIONS: Any cancellations will result in the forfeiture of deposit. No additions to
your registration list will be allowed on the day of Registration.
REGISTRATION TIMES: Churches’ registration times will be assigned alphabetically
according to the city your church is from. Registration times are as follows:
Cities beginning with A – K will register starting at 2:00 p.m. on Monday.
Cities beginning with L – Z will register starting at 3:00 p.m. on Monday.
Once the Contact Person has picked up their registration packet, he/she will distribute
materials and room keys to students and accompany them to their respective dorms.
Participants arriving at the dorms will be greeted by small group leaders who will help unload
their luggage.
After vehicles are unloaded, students are free to get settled into their rooms. They should
return to Roland Fine Arts Center by 3:55 p.m. for Orientation.
ORIENTATION:
There will be one orientation session for all participants, adults, and students. Orientation will be
held at 4:00 pm in Roland Fine Arts Center. All Super Summer attendees must attend
orientation.
You will go to dinner, as indicated on the 2015 schedule, immediately following Orientation.
Remember your first Team Meeting begins at 5:45 p.m. Don't be late!

RULES
SUPER SUMMER 2015
All participants and their parents/guardians must be aware of the expected order of conduct for Super Summer.
Failing to adhere to the following rules could result in the student’s early dismissal from Super Summer at the
church/parent/guardian’s expense.
1. Every participant is required to attend Monday through Friday of the week registered. Late arrivals or early checkouts are not permitted.
2. Students are not allowed off campus. No student is allowed to leave the campus at any time with anyone. Once
the student is registered, they MAY NOT leave campus until check-out time on Friday.
3. Students are not allowed to ride in or on any vehicle. Students and small group leaders will walk everywhere while
at Super Summer. All cars, vans, and buses must be parked and not used from Monday’s registration through Friday’s
final session. Those with personal needs should consult their Team Leader.
4. Students must attend all sessions. Late arrivals to, early departures from, or other activities/meetings during Super
Summer are not permitted for anyone for any length of time. Every student is required to attend every session.
5. Students must go straight to their classrooms and leave the building when each session is completed. Remember,
Hannibal-LaGrange University is an institution of higher learning conducting summer classes and regular business
affairs. We must be sensitive to their needs.
6. Students must be in the dorms and have lights out at the assigned times. Breaking curfew at Super Summer is
unacceptable for anyone – including adults. One violation will require an apology to the student’s entire team. Two
violations could be grounds for being sent home.
7. Drugs, alcohol, any form of tobacco, firearms, weapons, or any fireworks are not permitted. Students possessing
these at Super Summer will be sent home.
8. IPODs or any other mp3 players, CD players, televisions, all gaming systems, cell phones, laser pointers or any other
type of electronic device (except a basic alarm clock), and water guns are not allowed. They will be confiscated or
held by the youth leader and NOT returned until students leave on Friday.
9. Students must dress appropriately. If your clothes are a distraction to yourself or others, you will be asked to change.
The following items are permissible to wear: anything that is discrete & proper for a Christian environment including,
but not limited to, shorts, jeans, khaki/dress pants, t-shirts, polo & button down shirts. The following items are not
permissible: tight or form fitting clothing of any kind, sleeveless or cut-off shirts, halter or tank-tops, anything with
spaghetti straps, muscle shirts, shirts with any alcohol or tobacco or questionable slogans or bands, and shorts/pants
with writing on the back.
10. Any form of Public Displays of Affection (PDA) is not allowed.
11. Ordering food to be delivered on campus is forbidden.
12. Under NO circumstances are girls to be near or in the guys dormitories or vice versa.
13. Students must wear lanyards at all times. There will be a replacement fee of $5.00.
14. Students must keep track of room keys and key cards. Lost keys will cost $30.00 to replace. Lost key cards will cost
an additional $30.00 to replace. The church leader attending Super Summer with his/her students is responsible for the
keys checked out by his/her students. Payment MUST be made by the church leader at time of checkout for all lost
keys. No exceptions.
15. Students who are injured or ill should contact the Super Summer nurse immediately. The nurse is responsible for
diagnosing illness, not your roommate.
16. Churches are responsible for damage to campus/facilities. Because the University holds Super Summer responsible
for all damages, any damage or loss will be the responsibility of the churches involved. If no admission of guilt is made
regarding dorm room damage, each party in the room will be billed an equal portion of the cost of repair by the
church. A letter/bill will be sent following Super Summer.
17. Students are to stay in rooms assigned. Students are responsible for damages to room assigned. Changes must be
approved by Super Summer office. No exceptions.
Your cooperation is vital with hundreds of students and adults involved in a week of activities. We want the best for
each participant this week. We want SUPER SUMMER to be the greatest five days of your life. YOUR HELP in
accomplishing this goal by following these rules and making us aware of any special needs will be greatly
appreciated.
TENTATIVE SCHEDULE
SUPER SUMMER 2015
Monday
2:00-4:00 p.m.
4:00-4:30
Registration/Move luggage to rooms
Orientation
4:30-5:45
Dinner
5:45
7:45
10:00
10:30
11:00
11:30
Report to Team Meeting
To Evening Worship
Church Group Time
Fellowship/TBA
In Dorms
Lights Out
Tuesday-Thursday Mornings
7:15-8:15 a.m. Breakfast
8:15-8:45
Preparing for the Day
8:45-10:30
Team Meeting
10:30-11:30
Morning Show (All together in Roland)
11:30-12:00 p.m. Lunch 1
12:00-12:30
Lunch 2
Tuesday-Thursday Afternoons
12:45 p.m.
To Team Meeting
1:00-2:15
Team Meeting
2:30-4:30
Organized Recreation
4:45-5:15
5:15-6:00
Dinner 1
Dinner 2
6:00-7:00
7:00-9:30
9:30-10:15
10:15
11:00
11:30
Small Group Meetings
Evening Worship
Church Group Time
Fellowship/TBA
In Dorms
Lights Out
Friday Morning
7:30 – 8:30 a.m.
8:30 – 9:00
9:00 – 10:15
10:30 – 11:30
11:30
Breakfast
Pack/Clean
Final Team Meeting
Final Worship Celebration
Go home...
PACKING LIST
SUPER SUMMER 2015
Students and Leaders will need to bring the following items:
-- Bible, journal or notebook, and a writing utensil
-- Clean clothes – see #9 on the Super Summer Rules form for dress code
-- Bedding – pillow, sleeping bag or sheets & blanket, etc.
-- Towels, washcloths, personal toiletries, and all other basic essentials for a week away from home
-- Please see #8 on the Super Summer Rules form regarding electronic devices
-- All students are encouraged to bring at least one set of old clothes for some of the activities. There may be
messy games during the week! Girls, no white shirts for games (colored shirts only).
-- Money for the purchase of soda, pizza, and merchandise. There are snack/soda machines available on
campus. Your SUPER SUMMER T-shirt is included in your registration fee, but other sale items will be available.
CONTACT PERSON FORM
SUPER SUMMER 2015
CHURCH _________________________________________CHURCH PHONE (__________)_______________________
CHURCH ADDRESS __________________________________________________________________________________
CITY_______________________________________________ STATE ___________ ZIP ____________________________
CONTACT PERSON __________________________________________________________________________________
ADDRESS ___________________________________________________________________________________________
CITY_______________________________________________ STATE ___________ ZIP ____________________________
HOME PHONE (__________)________________________ WORK PHONE(__________)_________________________
EMAIL ADDRESS _____________________________________________________________________________________
WEEK YOUR GROUP PLANS TO ATTEND:
____________ Week 1: June 8-12, 2015 – Hannibal-LaGrange University, Hannibal, MO
____________ Week 2: June 15-19, 2015 – Hannibal-LaGrange University, Hannibal, MO
PAYMENT INFORMATION:
•
•
•
•
Early-Bird Student Registration Fee: $199.00 per student (if postmarked on/ before May 4, 2015)
Regular Student Registration Fee: $225.00 per student (if postmarked after May 4 and on/before May 26)
Late Student Registration Fee: $249.00 per student (if postmarked after May 26 and received by June 1)
Adult/Leader Registration Fee: $150.00
June 1, 2015 is the final day to register. All Registration/Medical Release Forms, HLGU Waviers, and
deposits must be in our (the MBC Leadership Development Team) office by 4:00 p.m. on Monday,
June 1, 2015. DEPOSITS ARE NON-REFUNDABLE!
NO REGISTRATION CHANGES WILL BE ACCEPTED AFTER JUNE 1, 2015.
* The remainder of your balance is due upon arrival at Super Summer.*
Please send all forms and deposits to:
Missouri Baptist Convention
Attn: Super Summer
400 East High St.
Jefferson City, MO 65101
It is required that one adult from each church attend Super Summer for every 10 student attendees. This
obligation can be fulfilled in one of two ways:
1. Attend Adult Leadership Development Training (ENGAGE).
2. Apply to serve as a small group leader.
We recommend sending your adults who work with your youth to the ENGAGE Training.
I verify that all forms are complete and correct.
Contact Person Signature_________________________________________
Date______________________
SUPER SUMMER OFFICE USE ONLY
Cash_________________ Check #______________ Total Amount $___________ Total Forms_____________
STUDENT & ADULT REGISTRATION FORM
12
SUPER SUMMER 2015
Type or print legibly in ink. Make sure all signatures are on form.
Registration Forms, Medical Release Forms, HLGU Waivers, and deposits must be postmarked
by May 4, 2015 to ensure the Early-Bird Student rate. DEPOSITS ARE NON-REFUNDABLE!
Final registration changes are due by June 1, 2015. Please send all forms and deposits to:
Missouri Baptist Convention
Attn: Super Summer
400 East High St.
Jefferson City, MO 65101
Name __________________________________ Gender _________ Birth Date ________/________/____________
Age ___________ School Grade in Fall 2015 _________________ Phone (_________) ______________________
Address __________________________________________________________________________________________
City __________________________________________ State ___________ Zip Code _________________________
Church:
City/State:
WEEK YOU WISH TO ATTEND:
____________ Week 1: June 8-12, 2015 – Hannibal-LaGrange University, Hannibal, MO
____________ Week 2: June 15-19, 2015 – Hannibal-LaGrange University, Hannibal, MO
APPROPRIATE TEAM: (match with school grade in Fall 2015, unless applying for Kaleo)
________ Red (8th)
________ Blue (9th)
________ Orange (10th)
________ Yellow (11th)
________ Green (12th)
________ Silver (College Freshman)
________ Kaleo (called to ministry)
________ ENGAGE (Adult)
T-SHIRT SIZE (Circle correct size below; t-shirt is included in registration cost.)
Small
Medium
Large
X-Large
2X-Large
3X-Large
Other ___________________
I have read, understand, and agree to abide by the Super Summer Rules.
___________________________________________________________
Participant Signature
__________________________
Date
The Missouri Baptist Convention will be videotaping and photographing at this event for possible
inclusion in future materials such as web and DVD formats for advertisement, newsletters, and other
promotional platforms.
By your signature of agreement to the terms and conditions, you are giving Missouri Baptist Convention
your consent to videotape, record, and cablecast you/your Child’s picture, likeness, voice and
statements. If this poses a threat to compliance with any Missouri state laws that might apply to the
participant, please call our office at 573.636.0400 ext. 329.
___________________________________________________________
__________________________
___________________________________________________________
__________________________
Participant Signature
Parent/Guardian Signature (if Participant is under 18)
Date
Date
MEDICAL RELEASE FORM
SUPER SUMMER 2015
Type or print legibly in ink. Make sure all information requested is given.
Name ____________________________________________ Gender _______________ DOB ________/________/___________
Age _____________
School Grade in Fall 2015 _____________________
Phone (________) _____________________
Address ___________________________________ City _________________________ State _______ Zip Code _____________
Church:
In event of emergency notify:
Name
Home Number
Work Number
Cell Phone Number
1.______________________________
(______) _____________
(______) _____________
(______) _____________
2.______________________________
(______) _____________
(______) _____________
(______) _____________
Allergies (reactions to foods, drugs, insects) ___________________________________________________________________
Do you have – or have had in the past – any medical conditions (such as asthma, heart trouble, TB, migraine
headaches, nervous disorder, stomach trouble, mono, diabetes, cancer, etc.) of which the MBC should be made
aware?
Yes
No
Please list and explain ________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Medications taking (and reason) ______________________________________________________________________________
______________________________________________________________________________________________________________
Date of last tetanus shot ___________________ Are you able to take Tylenol or other aspirin medications? __________
Medical, Surgical, and Liability Waiver
The person described on this registration form has my permission to be in all Super Summer activities at the place
named herein and on the dates named herein, except as noted by me. If a medical emergency should arise
while my child or ward is at Super Summer or in transit to Super Summer and I cannot be reached, I consent and
give my permission to the trip director or representative of Super Summer to select a physician and/or hospital for
my child’s or ward’s care. I also give the physician and/or hospital, as selected by the trip director or
representative of Super Summer, my permission to hospitalize, treat, give x-rays, tests and to order injections,
anesthesia, or surgery for my child who is named herein, which may in their sole discretion be necessary and
proper under the circumstances. I do release, acquit, discharge and covenant to hold harmless the (Church
Name) ___________________________of (City/State) ___________________________, the Missouri Baptist
Convention, its representatives, the trip director or Super Summer staff, of any and all actions, damages, or
liabilities arising out of the treatment of any sickness, or accident incurred by my said child or ward to disclose any
information there acquired, if requested. I understand that in the event of a medical emergency requiring
medical care, as I have authorized below, all costs for such emergency care ARE MY RESPONSIBILITY and I agree
to make payment of all such medical costs. I understand that I will be notified of medical care, and that I must
notify my insurance carrier.
Is this participant covered by Health Insurance?
Yes
If “Yes”, please attach a copy of his/her insurance card.
No
___________________________________________________________
__________________________
___________________________________________________________
__________________________
Participant Signature
Parent/Guardian Signature (if Participant is under 18)
Date
Date
Waiver and Release of Liability
Disclaimer: Hannibal-LaGrange University is not responsible for any injury (or loss of property) to
any person suffered while participating in an activity or event at Hannibal LaGrange University for
any reason whatsoever, including ordinary negligence on the part of Hannibal-LaGrange University,
their agents, instructors or employees.
In consideration of my participation in certain activities at Hannibal-LaGrange University, I hereby
release and covenant not to sue Hannibal-LaGrange University, Hannibal-LaGrange University
Board of Trustees, and any of their employees, instructors, or agents, from any and all present and
future claims resulting from ordinary negligence on the part of Hannibal-LaGrange University or
others listed for property damage, personal injury, or wrongful death, arising as a result of my
engaging in events or activities or any activities incidental thereto, wherever, whenever, or however
the same may occur. I hereby voluntarily waive any and all claims resulting from ordinary
negligence, both present and future, that may be made by me, my family, estate, heirs, or assigns.
Further, I am aware that some activities are vigorous involving severe cardiovascular stress. I
understand that these activities involve certain risks, including, but not limited to, death, serious neck
and spinal injuries resulting in complete or partial paralysis, brain damage, and serious injury to
virtually all bones, joints, muscles, and internal organs, I am voluntarily participating in these
activities with knowledge of the danger involved and hereby agree to accept any and all inherent
risks of property damage, personal injury, or death.
I further agree to indemnify and hold harmless Hannibal-LaGrange University, Hannibal-LaGrange
University Board of Trustees, and any of their employees, instructors, or agents for any and all
claims arising as a result of my engaging in these activities or any activities incidental thereto,
wherever, whenever, or however the same may occur.
I understand that this waiver is intended to be as broad and inclusive as permitted by the laws of
Missouri and agree that if any portion is held invalid, the remainder of the waiver will continue in
full legal force and effect. I further agree that the venue for any legal proceedings shall be in the
state of Missouri.
I affirm that I am of legal age and am freely signing this agreement. I have read this form and fully
understand that by signing this form, I am giving up legal rights and/or remedies which may be
available to me for the ordinary negligence of Hannibal LaGrange University, Hannibal-LaGrange
University Board of Trustees, and any of their employees, instructors, or agents.
Signature of Participant
Date
Signature of Parent/Guardian (if participant is under 18)
Date
HLG ROOMMATE PREFERENCE FORM
SUPER SUMMER 2015
CHURCH____________________________________CITY/STATE___________________
Use this sheet to indicate each participant’s roommate preference. Two people will
be placed in each room – please plan accordingly. We will do our best to put your
students together and adults together as they are listed on this sheet. Please note
there is a separate form for male and female participants. All Super Summer
participants from your group must be listed on the Roommate Preference Form –
including all adults/leaders.
Name (Female Students/Adults)
Age
Team Name/Color
1._____________________________
2._____________________________
______
______
___________________
___________________
1._____________________________
2._____________________________
______
______
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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HLG ROOMMATE PREFERENCE FORM (CONT.)
SUPER SUMMER 2015
CHURCH____________________________________CITY/STATE___________________
Name (Male Students /Adults)
Age
Team Name/Color
1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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1._____________________________
2._____________________________
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