VACATION BIBLE CAMP PARTICIPANT REGISTRATION FORM We are headed to a new camp location this year!

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Need Help? Have Questions? Email: vacationbiblecamp@thenbcf.org 425.282.6220 VACATION BIBLE CAMP PARTICIPANT REGISTRATION FORM We are headed to a new camp location this year!

1 Need Help? Have Questions? VACATION BIBLE CAMP PARTICIPANT REGISTRATION FORM We are headed to a new camp location this year! Crista Camps- Miracle Ranch Sidney Road SW, Port Orchard, WA This camp offers paintball, archery, horses, petting zoo, high & low ropes courses, lake front activities and much, much more! The Vacation Bible Camp team, the teachers and the counselors are excited about this weekend. Camp Dates: Friday, July 13th, 2018 Parent drop off at NBCF estimate 1:00pm Sunday, July 15th, Parent pickup at NBCF estimate 12:30pm Transportation: NBCF will provide transportation via First Student to and from the camp location. Times for check in/pick up will be confirmed shortly. Price: Total cost per student is $ Your cost $ We Got The Rest! But you have to make the Registration Deadline of May 31st, 2018 You may still register until June 15th, 2018, however it will be full price and only is space available. CHECKLIST FOR APPLICATION Submit one complete application per student (pages 2-6) Only complete Family Summary Sheet if more than one student is attending camp. Complete all segments of application; simply mark N/A if it does not apply. Grade refers to grade student was in during the school year. Ministry & Church Form- Obtain church school teacher or ministry lead signature. Submit proof of payment, if available. Change of place + Change of pace = Change in perspective.

2 2018 VACATION BIBLE CAMP COMPLETE ONE FORM FOR EACH CAMPER Participant Information Camper Name: Cell Phone #: ( ) Birth Date: / / Age: Gender: F M Current Grade: School: Home Address: City, State, Zip: Home Phone ( ) Emergency Information Parent/Legal Guardian/ Emergency Contact #1: Relationship: Best way to contact: Home Phone Cell Phone Home #: ( ) Cell # : ( ) Parent/Legal Guardian/ Emergency Contact #2: Relationship: Best way to contact: Home Phone Cell Phone Home #: ( ) Cell #: ( ) Is anyone legally restricted from being in contact with any of your child? YES NO If YES, who (Full Name): Medical Insurance Medical Insurance Carrier Policy or Group # Patient ID # Name of insured person Health Information (check all that apply) Hypoglycemic Asthma Bleeding Disorders Heart Defect/Disease Seizures Food Allergies Drug Allergies Other Allergies Other conditions that may impact the ability of the child to safely participate in activities: Dietary Restrictions (please be specific) Current Medications (please list ALL prescription, over-the-counter, and herbal) Current Medical Equipment Needed

3 Page -3- VACATION BIBLE CAMP 2018 Health and Emergency Information Form Participant Name Safety Information Participants will have the opportunity to participate in OPEN SWIM where a certified Life Guard will be on duty. Describe your child s swimming ability: Non-Swimmer Beginner Intermediate Advanced Initial I give permission for my child to sleep on a top bunk. Other concerns: Illness or Accident at Camp: New Beginnings Christian Fellowship will make reasonable attempts to notify Parent/Legal Guardian/Emergency Contact if a child becomes sick or sustains an injury in which general first aid is not sufficient and treatment by a physician is necessary. (Initial) I give my permission to the staff administrator or nurse to administer Tylenol/ acetaminophen, ibuprofen, Benadryl, or over-the-counter antacids as needed.

4 Page -4- VACATION BIBLE CAMP 2018 REGISTRATION FORM, RELEASE, AND INDEMNIFICATION STATEMENT OF UNDERSTANDING AND MEDICAL CONSENT I, the undersigned parent or legal guardian of (the Child ), have legal custody of the Child, a minor, and give my consent for the Child to attend events being organized by New Beginnings Christian Fellowship ( NBCF ). I understand that there are inherent risks involved in any NBCF ministry, activity, or athletic event and that no degree of care or caution can completely eliminate these risks. I release and agree to hold harmless, defend and indemnify NBCF and its directors, officers, employees, volunteers and agents ( Releasees ) from and against any and all claims for personal injury (including loss of life) and all other losses or damages (except that Releasees shall not be released, held harmless, defended or indemnified for the Releasee s gross negligence or willful misconduct) that the Child or the Child s parent(s) may suffer as a result of the Child s participation in or transportation to and from these ministries, activities, or athletic events. I acknowledge that the Child s participation in the activities of NBCF Vacation Bible CAMP 2018 is voluntary and may require traveling and participation in physical exertion. The Child has my permission to participate without restriction in all NBCF Vacation Bible CAMP 2018 activities, which may include, but are not limited to the following: cookouts, camp fires, swimming, zip line, hiking, soccer, volleyball, softball, basketball, Horses or Ponies, Challenge Course, High or Low Ropes Course, paint ball, and Running.g wall. In consideration of the activity or event in which the Child is involved, I hereby represent and warrant that the Child is physically and medically capable of fully partaking in any activity or event. IF CHILD DOES HAVE LIMITATIONS FOR PARTICIPATION, PLEASE SPECIFY: I grant permission to NBCF and its employees, volunteers and agents to take the Child to a licensed physician for medical treatment, emergency surgery, or hospitalization if the Child becomes ill or sustains an injury or otherwise requires medical treatment or attention and NBCF cannot contact me within a reasonable period of time. I give my consent to any licensed physician to administer drugs or medicine or to perform such medical procedures as that physician determines necessary for the relief of pain or to preserve the Child s life or health. I agree to assume the responsibility for all medical, transportation, rescue and other related expenses incurred on behalf of the Child in the event the Child receives medical attention. I grant permission to NBCF to use the Child s name and/or photograph for use in publications such as newsletters, recruiting brochures, pamphlets, website promotions, magazines, display boards, or other electronic forms of media, for the purpose of promoting the vision, mission, or activities of NBCF and its subordinate entities. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph. I agree to release, defend, and hold harmless NBCF and its directors, officers, employees, volunteers and agents, or any firm publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication, or distribution. By sharing my address and phone number, I authorize NBCF to communicate information regarding Vacation Bible CAMP 2018 electronically and by phone. This document contains a release and waiver of liability. Please read carefully before signing. By my signature below, I acknowledge that information that I have provided on this form is correct and agree to the terms therein. PARENT/LEGAL GUARDIAN SIGNATURE: DATE: PRINTED NAME: PARENT

5 Page -5- VACATION BIBLE CAMP 2018 Ministry Service / Church School Form Each participant will be required to obtain the signature of either their Church School Teacher and/or Ministry Leader. Vacation Bible Camp is for our children and youth who demonstrate an earnest investment in their spiritual development and stewardship in service. Note: Participants will not be allowed to register without a signed ministry service or church school form. Participant Name: Cell Phone #: ( ) Birth Date: / / Age: Gender: F M Grade: School: Church School Class 2018 Attendance: Regular Sporadic Lead Teacher (Print Clearly) Signature Ministry Name Date 2018 Participation: Regular Sporadic Ministry Lead (Print Clearly) Signature Official Use Only Completed Application Church School / Ministry Lead Signature Health & Emergency Contact NBCF Wavier Miracle Ranch Waiver Family Summary Sheet (if applicable) Payment Verification Comments: Date

Agreement for Waiver and Release, Assumption of Risks & Indemnification (rev 1/10) NOTICE: This document affects your legal rights, please read carefully.

This Agreement constitutes the entire Agreement and shall not be modified except via written document, executed by both parties.

6 Agreement for Waiver and Release, Assumption of Risks & Indemnification (rev 1/10) NOTICE: This document affects your legal rights, please read carefully. Handwritten changes to this document are not permitted and will not be honored. This Agreement constitutes the entire Agreement and shall not be modified except via written document, executed by both parties. If any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. Event Name Participant Name Date of birth: Sex Age Parent / Guardian Name Mailing address: City: State: Zip Home phone: ( ) Work phone: ( ) Emergency contact: Primary doctor: Cell Phone: ( ) Emergency phone: ( ) Phone: ( ) Health insurance provider: Group policy #: Policyholder: Policyholder s #: Please do not send me information regarding CRISTA Camps events. I, the above Participant or the Parent/Legal Guardian of participant, being above the age of 18, agree as follows: I acknowledge and understand that certain camping activities, including but not limited to: skating, skateboarding, paintball, ropes courses, archery, marksmanship, water sports, horses and dirt bikes are hazardous and dangerous activities that require strenuous exercise and varying degrees of skill and experience. I understand that these activities can result in serious injury to the person and damage to property and I voluntarily assume any and all risks of loss, damage or injury while on the premises. I acknowledge that there are risks, hazards and dangers of personal injury, death and disability inherent in entering camp grounds and participating in, or viewing camp activities. I am aware that the usual risks, hazards and dangers of personal injury, death and disability increase when using certain camping equipment and when other persons, whether of the same or different level or experience or skill, are using the same facilities and equipment. In consideration for my participation, or for the participation of my child or the minor for whom I represent that I am legal guardian, I hereby release and forever discharge Island Lake Camp, Miracle Ranch Camp, and CRISTA Ministries, and their servants, employees, officers, directors, trustees and all other persons or entities acting on their behalf (collectively referred to as CRISTA ), from any and all claims, actions, damages, liabilities, costs or expenses and attorney fees which are related to, arise out of, or are in any way connected to my, my child s, or the minor for whom I represent that I am legal guardian s viewing or participation in any camping activities. By signing this Agreement, it is my intention to waive any rights to sue or seek damages from CRISTA; except where injury, death or disability results from CRISTA s gross negligence. I further agree to indemnify, hold harmless and defend CRISTA against any and all claims for damages, costs, expenses or attorneys fees brought by any third party in connection with or arising out of my, or the above-listed participant s involvement or participation. This Agreement shall be effective and binding upon my marital community, estate, heirs, agents, personal representatives and assigns. Emergency Consent: (participant s name) may receive emergency and/or routine medical care from a physician or emergency facility if I am incapacitated (if participant), or cannot be reached in an emergency (if parent/guardian). Photo Release: CRISTA may publish photos taken of participant and I release all rights to remuneration for such photos. I hereby certify that I am over 18 years of age; I have carefully read the foregoing and acknowledge that I understand and agree to all the terms and conditions. I have had the opportunity to ask any and all questions regarding this Agreement and the effect of the same. I am aware that by signing this Agreement, I assume all risks and waive and release certain substantial rights that I have or possess. Participant Signature (on behalf of marital community) Date Parent/Legal Guardian Signature (on behalf of marital community) Date Additional Indemnification for Parents/Guardians Must be completed for participants under the age of 18. In consideration of s (print minor s name) ( Minor ) participation in Camps activities including the use of Camps equipment and facilities, I further agree to indemnify and hold CRISTA harmless from any and all claims which are brought by, or on behalf of Minor and which are in any way connected with such use or participation by Minor. Parent/Legal Guardian Signature (on behalf of marital community) Date

7 VACATION BIBLE CAMP 2018 REGISTRATION FORM #1 Child s Name #2 Child s Name #3 Child s Name #4 Child s Name Emergency Information #1 Parent/Legal Guardian/Emergency Contact Relationship Best Way to Contact Home Phone Cell Phone Home Phone ( ) - Cell Phone ( ) - #2 Parent/Legal Guardian/Emergency Contact Relationship Best Way to Contact Home Phone Cell Phone Home Phone ( ) - Cell Phone ( ) - Primary Home Address City, State, Zip Home Phone ( ) - Is anyone legally restricted from being in contact with your child(ren)? Yes No If YES, who (Full Name)

There are a few things we need from you to make sure we are able to create the best camping environment possible:

There are a few things we need from you to make sure we are able to create the best camping environment possible: Dear Counselor Applicant: The WAPAC Kid s Camp Team would like to thank you for offering your time to make a difference in the lives of children during the week of camp. Being a counselor is an awesome