Camp Registration Form

Transcription

1 Camp Registration Form Kids Camp 2018 is July Payment (which includes a $50 non-refundable deposit) should be made directly to your church s Children s Ministry. Please fill out this form (in addition to the one like it you did online), so that we will have a hard copy to keep with all other camp documentation as quick reference should an emergency arise. Please fill out separate forms for each child that you will send to camp. The camp fee includes a Camp T-Shirt so please make sure to indicate the correct size for your child. Camper s Name: Camper s Age: Grade Just Completed: Birthday: Parents Name(s): Address: Best way to contact you (phone or ): Any concerns or special requests (dietary, etc.): Camper s T-shirt size (circle one): YS YM YL AS AM AL AXL

2 Waiver of Liability For Minors For The Vineyard Church This release and Waiver of Liability (the Release ) executed on this day of, 2018, by the minor named below in favor of The Vineyard Church, a nonprofit corporation organized and existing under the laws of the State of Texas, USA, its directors, officers, employees, and agents (collectively, Vineyard ). I, the Minor:, desire to participate in activities at Vineyard Kids Camp in connection with the youth program of Vineyard and engage in the activities related to this event, and hereby freely and voluntarily, without duress, execute this Release under the following terms: 1. Waiver and Release. The guardian and minor release and forever discharges and hold harmless Vineyard and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the minor s volunteer participation at Vineyard. The guardian/volunteer understands and acknowledges that this Release discharges Vineyard from any liability or claim that guardian and minor may have against Vineyard with respect of bodily injury, personal injury, illness, death, or property damage that may result from participation with the Vineyard on or off its property. It is also understood that Vineyard does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance in the event of injury, illness, death or property damage. 2. Insurance. The guardian and minor understands that we expressively waive any such claim for compensation or liability on the part of Vineyard beyond what may be offered freely by the representative of Vineyard in the event of such injury or medical expense. 3. Medical Treatment. The guardian and minor hereby release and forever discharge Vineyard from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during the minors time with Vineyard. 4. Assumption of Risk. The guardian understands that the minors time with Vineyard may include activities that may be hazardous to them including, but not limited to, paintball, athletic or sports activities, participation projects, and local transportation. We recognize and understand that the minor s time with Vineyard may, in some situations, involve inherently dangerous activities. As the guardian for the said minor I hereby expressly assume the risk of injury or harm in these activities and release Vineyard from all liability for injury, illness, death or property damage resulting from the activities of the minor s time at Vineyard.

3 5. Photographic Release. As the guardian of said minor I grant and convey unto Vineyard all right, title, and interest in all photographic images and video or audio recordings made by Vineyard during the minor s participation with Vineyard. Or, if signed here, I do not want images or recordings made of my child used in any way: 6. Other. As a participant I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Texas in the United States of America, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Texas. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall no otherwise affect the remaining provisions of this Release, which shall continue to be enforceable. To express my understanding of this Release, I sign here: Name of Parent or Guardian: Signature of Parent or Guardian: Date: Name of Dependent / Minor: Birthdate of Minor: Signature of Minor: Date: Address: Phone Number: Emergency Contact Name: Phone Number: Insurance Company: Policy Number: Policy Holder s Name: The Vineyard Church 5015 Grove West Blvd. Sugar Land Tx

4 VINEYARD KIDS CAMP NURSE S QUESTIONNAIRE Name of camper Weight Height Allergies Special Considerations / Diet Has child been to camp before? Yes No Has child had any problems with homesickness? Yes No If yes, how would you like this handled? Has your child suffered from dehydration before? Routine Medications: 1. Name dosage how often 2. Name dosage how often 3. Name dosage how often Do you give the camp nurse permission to treat minor pain and/or fever with: Tylenol? Yes Ibuprofen? Yes No No Do you give the camp nurse permission to treat allergic response to insect bites or poison ivy/oak with Benadryl? Yes No Do you give the camp nurse permission to treat upset stomach or diarrhea with Pepto Bismol? Yes No Imodium? Yes No Date of last tetanus shot Parent or Guardian signature Date: Please remember to send sunscreen and insect repellant with your child. Send sufficient prescription medication to last the length of camp. Please inform your child that the camp nurse will hold all medication.

5 Head Lice Check Verification Kids Camp 2018 Camper s Name Age: Grade: Date check performed (must be done the week before camp): Check performed by: Child is lice-free and cleared to attend camp: Yes: No: Notes: Signatures: Parent / Guardian Date Person Performing Check: Children s Pastor or Camp Coordinator: Date Date

6 GROUP NAME: The Vineyard Church (Sugar Land / Stafford) INDIVIDUAL ASSUMPTION OF RISK, WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT Each participant must fill out this form. All forms should be turned in to Camp Cho-Yeh before or upon arrival. I wish to enter onto Camp Cho-Yeh s premises and to participate in recreational activities to be made available to participants at Camp and Conference Center, Inc. I am aware that there are a number of risks of injury and death at Camp Cho-Yeh. I am aware that Camp Cho-Yeh has a lake on site and has direct access to a swimming pool. Therefore, I may have the opportunity to participate in aquatic activities including, but not limited to, swimming, kayaking, fishing and any other activity arranged for me by the group leader and Camp Cho-Yeh s Staff. I acknowledge that it is the full responsibility of me (or legal guardian if under the age of eighteen) to decide on and carry out any activity restrictions I (or legal guardian) deem personally necessary. I acknowledge that non-swimmers or weak swimmers should not participate in aquatic activities. I understand Camp Cho-Yeh also offers activities on a Challenge Course. This Course includes elements as high as forty-five (45) feet high with which a belay system is used as well as low elements approximately six (6) feet high with which group spotters are used. I understand that Camp Cho-Yeh offers activities on a paintball course. I acknowledge that paintball is a strenuous activity in which participants can and do get injured including the lower body, mid-section, upper body, and head. In addition, marks are usually left on the skin when a paintball makes contact with a participant. I understand other activities include, but are not limited to, team and individual sports, miscellaneous games, and all aspects of camping. I am aware and understand that the activities discussed in this document are only some examples of risks of injury and death at Camp Cho-Yeh, and that these and/or other activities in which I participate during my stay at Camp Cho-Yeh (the Activities ) may be hazardous or otherwise involve a risk of physical injury or death to participants. I understand hazards include, but are not limited to, the hazards of being in a wilderness area, the forces of nature, and other reasons associated with the activities. In consideration of Camp Cho-Yeh permitting me to enter upon premises owned or controlled by Camp Cho-Yeh, to participate in Activities at Camp Cho-Yeh, and/or to use any equipment owned or controlled by Camp Cho-Yeh, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I agree as follows: I expressly assume any and all risks of injury or death arising from or relating in any way to the following Causes : (i) my ingress, egress or presence or activity on Camp Cho-Yeh s premises (including but not limited to participation in Activities defined above), (ii) the condition of Camp Cho-Yeh s premises, the adjoining land, or any of the driveways, streets, or alleys used in connection with Camp Cho-Yeh s premises, or (iii) the use or condition of any equipment on Camp Cho-Yeh s premises or equipment owned or controlled by Camp Cho-Yeh, or (iv) any act or omission of Cho-Yeh Camp and Conference Center, Inc., its affiliates, contractors, vendors, directors, officers, agents, sponsors, employees, staff, volunteers, or representatives of any kind (collectively Releasees ). On behalf of myself, my dependents and personal representatives, I hereby agree to waive and release any and all actions, claims, suits or demands of any kind or nature whatsoever against the Releasees arising from or relating in any way to any of the Causes. I understand and agree that this Individual Assumption of Risk, Waiver, Release and Indemnification Agreement means, among other things, that if I am injured or die as a result of any of the Causes, I, m y family, m y heirs, and others cannot under any circumstances sue Releasees or any of them for dam ages relating to or caused by my injuries or death. I agree to indemnify, to the extent permitted by the laws and constitution of the State of Texas, Releasees or any of them, and their subrogees, if any, in the event of any loss, damage or claim (including court costs and attorneys fees) for my injury or death arising from or relating in any way to any of the Causes. MY ASSUMPTION OF RISK, WAIVER, RELEASE, AND OBLIGATIONS TO INDEMNIFY THE RELEASEES UNDER THIS DOCUM ENT SHALL APPLY TO LIABILITIES EVEN IF SUCH LIABILITIES ARE CAUSED IN WHOLE OR IN PART BY THE SOLE, JOINT, OR CONCURRENT NEGLIGENCE, FAULT OR LIABILITY OF ANY ONE OR MORE OF THE RELEASEES, WHETHER OR NOT SUCH SOLE, JOINT, OR CONCURRENT NEGLIGENCE, FAULT OR LIABILITY WAS ACTIVE OR PASSIVE. I understand and agree that I would not have been permitted upon premises owned or controlled by Camp Cho-Yeh, and/or to use any equipment owned or controlled by Camp Cho-Yeh had I not executed this Individual Assumption of Risk, Waiver, Release and Indemnification Agreement. I have read this Assumption of Risk, Waiver, Release and Indemnification Agreement, have asked and received answers to any questions I had concerning its meaning, and execute it freely, without duress, and in full complete understanding of its legal effect, and of the fact that it may affect my legal rights. I hereby consent to and authorize Camp Cho-Yeh to use and reproduce any photographs and/or video taken of me for the purposes of web and print media designs and publications, and I will not receive compensation for such use. Date Signature of Participant Printed Name of Participant Street Address City State Zip (optional) FOR PARTICIPANTS UNDER THE AGE OF EIGHTEEN I am the parent or legal guardian of the child whose name and signature appear above. I have read and understand this Assumption of Risk, Waiver, Release and Indemnification Agreement, and consent on behalf of the Participant to its terms. Date Signature of Parent Printed Name of Parent Date Signature of Witness Printed Name of Witness Emergency name and phone number in the event the above cannot be reached. Printed Nam e of Contact Primary Phone Number Secondary Phone Number

7 What to bring to Kids Camp: Any medications (allergy or otherwise) MUST be clearly labeled in ORIGIONAL PACKAGING, and given to your Children s Pastor or church s Camp Liaison BEFORE you leave the day of camp. These will go to the Camp Nurse in a separate container marked for each attending church. Daily Camp Mail (one letter or more for each day by you, friends or relatives) in individual envelopes clearly labeled with your child s full name and Day 1, Day 2 etc To be turned in to your Children s Pastor before the day of camp. Optional Extra money ($2 per day) for snacks, if you desire. You can include it in your daily camp mail to your child if you prefer. Bedding (sleeping bag, pillow, sheets (twin size bed), blanket, etc.) Bible, notebook, pen 3 towels 2 Beach towels, 1 Bath towel Toiletries toothbrush, hairbrush, SOAP, deodorant, washcloth, shampoo, toothpaste Casual clothes 2 sets per day as we ll get hot and messy! Shorts and T- shirts recommended. Please don t bring your favorite clothes, just in case they are lost or ruined. Optional Trash bag to put messy clothes in Swimsuit (girls need a one-piece) 1 Pair of closed-toed shoes that can be worn in the lake, preferably a pair of water shoes Tennis shoes NOT THE SAME PAIR AS YOUR LAKE SHOES! Water Bottle, if you d like one Sunscreen 1 Flashlight Camera (disposable with your name written on it) A great attitude! Please Leave These Items At Home: ipods, Game Boys, electronics etc. Cell phones or pagers Valuable jewelry, etc. No sandals or flip-flops no open-toed shoes Shirts with spaghetti-straps, camisoles etc. You will be required to put another shirt on top of this kind of shirt. The Vineyard Church 5015 Grove West Blvd. Sugar Land Tx