UED ( ) Summer Camp 2015

Transcription

1 UED ( ) Summer Camp 2015 Registration Form UED Summer Camp 2015 Student Information who current 4th and 5th graders when 7/2 (thurs) - 7/4 (sat) where Pinecrest Christian Conference Center 1140 Pine Crest Road Twin Peaks, CA cost Early Registration - $100 (5/17-6/7) *first come first serve Late Registration - $120 (6/8-6/21) *upon availability CASH or CHECK (Please make checks BLANK) Office Use Only Name (English) (Korean) I am currently in 4th grade 5th grade Small Group # Teacher I attend 2nd service 3rd service Check if you do not attend Sa-Rang Community Church Parent Information Parent s Name Parent s Contact (Cell) (Work) Parent s Scholarship Available UED is very excited and grateful to announce that scholarships are available for this year s summer camp. UED has limited number of scholarships on first come first serve basis with priority given to Sa-Rang Community Church members. We want your child to attend this year s camp regardless of your financial circumstances so that he or she can be truly blessed and touched by our Lord. If you would like your child to receive scholarship, please do not hesitate to sign below. If however, you would like to pass this opportunity to another child who would better benefit from this offer, please disregard the signature section below. 초등부학부모님들께금년여름캠프장학금에대해알려드립니다. 하나님의축복으로한정된양의장학급이제공됩니다. 각가정의재정상황을떠나이번캠프를통해우리학생들이하나님의사랑과은혜를마음껏체험하기원합니다. 장학금이필요하신가정은밑에싸인을해주시기바랍니다. 만약장학금이더필요한학생 / 가정에이번기회가더적합하다생각하신다면밑에칸을비워주시기바랍니다. 장학금은선착순이며남가주사랑의교회교인에게먼저적용됩니다. Scholarship Request Date We Welcome Donations! 도네이션받습니다! $$ $ To make a donation to this camp, you can include in the registration fee or pay separately in cash or check (please make checks BLANK) Thank you for your support! :) Read & Fill Out Next Few Pages Questions? P Hanna

2 UED/ 초등부 Summer Camp 2015 MEDICAL CONSENT / WAIVER AND RELEASE FORM Child s/minor s Name: ( Participant ). In consideration for permitting Participant to participate in Sa-Rang Community Church summer retreat activities, I acknowledge and agree to the following provisions. Acknowledgment of Risks. I understand that there are certain risks associated with participation in camping, hiking or any other outdoor activities ("Activities"). I recognize and am aware that there is always the potential for accidents to occur, including but not limited to mild or severe bodily injury, including illness and fatalities. For this and other reasons, some risk cannot be eliminated, altered or controlled, such as: Activities often take place in a natural environment where unexpected and unmarked objects and conditions potentially create a risk of injury from tripping and falling, insect or animal contact, and potentially harmful vegetation; Weather conditions, which may change rapidly and unpredictably, potentially causing injury directly ( i.e. sunburn, hot/cold temperature extremes) or by affecting other factors ( i.e. performance of equipment may be impaired). Activities in or near water potentially involve risks of injury, illness and drowning. Lakes, ponds, rivers and other bodies of water present risks of water movement, subsurface conditions, cold water temperatures, water impurities and the like. There is also the risk of falling from or being struck by a water craft. Motor vehicle accidents may occur in the course of transporting Participant from location to location. A complete listing of all risks is not possible. These are just some but not all of the risks inherent in the Activities. There are also some risks that cannot be reasonably anticipated. Church staff and volunteers shall use their best judgment in determining how to react to circumstances. Obligations of Participant. Each Participant is expected to: Obey all posted rules and regulations of the camp facilities, especially those designed to limit injury to the Participant or others and follow the instructions of group leaders and supervisors assigned to Participant; and Assist by informing/alerting the group leaders or supervisors to situations that may cause injury to Participant or others. Waiver and Release. I understand that Sa-Rang Community Church, its employees, officers, directors, agents, staff and volunteers ( Sa-Rang ) assumes no responsibility for personal injuries (including loss of life) resulting from Participant s participation in any and all Activities. For valuable consideration, a receipt of which is acknowledged, I hereby release Sa-Rang from any and all rights, claims, demands, causes of action, and damages of any kind, known or unknown, existing or arising in the future, resulting from or related to personal injuries and/or property damage, arising from Participant's participation in the Activities. Furthermore, I agree to hold harmless, defend and indemnify Sa-Rang from and against any and all claims (except those caused entirely by the gross negligence or intentional conduct of Sa-Rang) that may arise as a result of Participant's participation in the Activities. If any part of this agreement is found to be null and void such action shall not void any other part of this agreement. Consent and Acknowledgments. I authorize Sa-Rang to administer first aid, CPR or other treatment by a qualified staff member to Participant. I further grant Sa-Rang the authority to release Participant, for the purpose of providing medical treatment, to the care of medical personnel or physicians as reasonably appropriate. I consent to a licensed physician to administer drugs or medicine or to perform such medical procedures as that physician determines necessary for the relief of pain and to preserve the Participant s life or health. I understand that in the event that Participant is not covered by his/her own medical insurance or if such policy does not fully cover all incurred expenses, I, as the parent or guardian, shall assume and be deemed financially responsible for all such costs and expenses incurred by Participant. I have read and fully understand the terms of this agreement. I give my fully informed consent and permission for Participant to participate in all camp activities. Print Parent s/legal Guardian s Name: Signature: Date: Rev

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