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If Participant has a non-binary gender identity, please contact the camp director to explore how we can be inclusive and welcoming.

Parent/Legal Guardian 1:

Parent/Legal Guardian2:

I hereby give permission for the following people, other than parents/guardians listed above, to pick up camper (please list - anyone picking up camper must be 18).

Emergency Contact 1:

Emergency Contact 2:

MEDICAL HISTORY - Please check Yes or No and explain any "Yes" answer

Are you allergic to any foods, latex, medications, etc.?

Are you presently under a physician's care for any acute/chronic medical condition?

Are you currently taking any medications?  If yes, please list (include dosage instructions or attach a list with this form).  A Healthcare Provider Authorization is required for any prescription medications your child will bring to camp.  Bring it to camp with you.

Does camper have any physical, emotional, medical, or psychological conditions or restrictions? If yes, please list ;

Have you had any recent/major emotional upset, illness, injury, surgery, or exposure to contagious disease?   If yes, please describe (include dates or attach additional information).

Please send a photocopy of a current health insurance card which covers the Registrant to brussellcofchrist@gmail.com

PLEASE READ!  Some of our events MAY have t-shirts.  Please share your t-shirt size if you want one.  T-shirt Size(s): Both of these fields are required.  If you do not need a shirt in the size category (Adult or Youth) please select the 'I do not need...' option under that question.

Release and Consent

Please read each of the following Release and Consent Statements and sign this registration form. Your signature indicates your consent.

Consent to Medical Treatment

As the Registrant, or if under the age of 18 (19 in Alabama, Alaska, Wyoming and Nebraska, 21 in Pennsylvania, Puerto Rico, Mississippi and Colorado), the parent or legal guardian of the Registrant listed on this form, I give permission to Community of Christ to transport the Registrant to a physician or hospital and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and I will assume the responsibility for payment of all expenses and bills resulting from medical treatment. Community of Christ personnel may administer prescription medication as needed during the Event, and I agree that if the Registrant has an illness on the day the Event begins that could be harmful to him/her or to others, he/she will not be allowed to begin the Event.

Consent to Participate in Event Activities

As the Registrant, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older (19 in Alabama, Alaska, Wyoming and Nebraska, 21 in Pennsylvania, Puerto Rico, Mississippi and Colorado), specifically consent to the participation in all activities offered at the Event. Any activities to which I do not consent are listed here:

Waiver and Release of Liability

In consideration for acceptance for my participation in the Event, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older (19 in Alabama, Alaska, Wyoming and Nebraska, 21 in Pennsylvania, Puerto Rico, Mississippi and Colorado), hereby release, forever discharge and agree to hold harmless Community of Christ and its affiliated organizations, lessors, lessees, officers, representatives, subordinate units, contractors, campgrounds, Event directors, staff, priesthood, agents, volunteers, participants, and employees thereof from any and all damages (including consequential damages), liability, claims, judgments, penalties, obligations, fines, causes of action, demands, losses, costs, and expenses (including without limitation reasonable attorneys’ fees and court costs) for personal injury, sickness or death based upon ordinary negligence, as well as property damage and expenses of any nature whatsoever which may be incurred by the parent/guardian and the Registrant occurring while Registrant is participating in the Event or arising thereafter, and further agree to hold harmless and indemnify said organizations and their lessors, lessees, officers, representatives, subordinate units, contractors, campgrounds, Event directors, staff, priesthood, agents, volunteers, participants, and employees for any liability sustained by them as the result of the negligent, willful or intentional acts of said Registrant during the Event, including expenses incurred attendant thereto.

Photo Release

In consideration for acceptance for my participation in the Event, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older (19 in Alabama, Alaska, Wyoming and Nebraska, 21 in Pennsylvania, Puerto Rico, Mississippi and Colorado), hereby give consent to and authorize the taking of photographic, audio or video recordings in which the Registrant may appear; and hereby waive all right of privacy in and to any of said pictures or tapes and authorize the use of the recordings by Community of Christ for any and all official resource, use or purpose including but not limited to print, film, or electronic media and reproduction or digital representation of every description on the internet/world wide web.

Event Rules

Possession of fireworks, firearms, fixed or switched blade knives (except under supervision by Event staff), any other weapons, alcohol, tobacco products, marijuana, illegal drugs or other controlled substances or their imitations are strictly forbidden. Additional Event Rules are attached and incorporated by reference to this agreement.

TRANSPORTATION CONSENT*

I understand that some activities involved in by this camp may require travel to other locations. I understand that all transportation during this youth camp will be provided by camp staff or people designated by them and that all drivers of vehicles will be licensed and over the age of 25. I understand that most transportation will be in privately owned vehicles that are in good condition and considered safe.

STATEMENT OF CONSENT AND RELEASE

I, the undersigned, have read and consent to the rules, guidelines and releases specified in this form.

I have read, understand, and agree to abide by the Event Rules.

Registrant Information:

Parent/Legal Guardian:

Parent/Legal Guardian:

Emergency Contact:

MEDICAL HISTORY - Please check Yes or No and explain any "Yes" answer

Please send a photocopy of a current health insurance card which covers the Registrant to brussellcofchrist@gmail.com

Release and Consent

Please read each of the following Release and Consent Statements and sign this registration form. Your signature indicates your consent.

Consent to Medical Treatment

As the Registrant, or if under the age of 18 (19 in Alabama, Alaska, Wyoming and Nebraska, 21 in Pennsylvania, Puerto Rico, Mississippi and Colorado), the parent or legal guardian of the Registrant listed on this form, I give permission to Community of Christ to transport the Registrant to a physician or hospital and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and I will assume the responsibility for payment of all expenses and bills resulting from medical treatment. Community of Christ personnel may administer prescription medication as needed during the Event, and I agree that if the Registrant has an illness on the day the Event begins that could be harmful to him/her or to others, he/she will not be allowed to begin the Event.

Consent to Participate in Event Activities

As the Registrant, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older (19 in Alabama, Alaska, Wyoming and Nebraska, 21 in Pennsylvania, Puerto Rico, Mississippi and Colorado), specifically consent to the participation in all activities offered at the Event. Any activities to which I do not consent are listed here:

Waiver and Release of Liability

In consideration for acceptance for my participation in the Event, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older (19 in Alabama, Alaska, Wyoming and Nebraska, 21 in Pennsylvania, Puerto Rico, Mississippi and Colorado), hereby release, forever discharge and agree to hold harmless Community of Christ and its affiliated organizations, lessors, lessees, officers, representatives, subordinate units, contractors, campgrounds, Event directors, staff, priesthood, agents, volunteers, participants, and employees thereof from any and all damages (including consequential damages), liability, claims, judgments, penalties, obligations, fines, causes of action, demands, losses, costs, and expenses (including without limitation reasonable attorneys’ fees and court costs) for personal injury, sickness or death based upon ordinary negligence, as well as property damage and expenses of any nature whatsoever which may be incurred by the parent/guardian and the Registrant occurring while Registrant is participating in the Event or arising thereafter, and further agree to hold harmless and indemnify said organizations and their lessors, lessees, officers, representatives, subordinate units, contractors, campgrounds, Event directors, staff, priesthood, agents, volunteers, participants, and employees for any liability sustained by them as the result of the negligent, willful or intentional acts of said Registrant during the Event, including expenses incurred attendant thereto.

Photo Release

In consideration for acceptance for my participation in the Event, or as parent/guardian of the Registrant, I do for myself and on behalf of the Registrant, if said Registrant is not 18 years of age or older (19 in Alabama, Alaska, Wyoming and Nebraska, 21 in Pennsylvania, Puerto Rico, Mississippi and Colorado), hereby give consent to and authorize the taking of photographic, audio or video recordings in which the Registrant may appear; and hereby waive all right of privacy in and to any of said pictures or tapes and authorize the use of the recordings by Community of Christ for any and all official resource, use or purpose including but not limited to print, film, or electronic media and reproduction or digital representation of every description on the internet/world wide web.

Event Rules

Possession of fireworks, firearms, fixed or switched blade knives (except under supervision by Event staff), any other weapons, alcohol, tobacco products, marijuana, illegal drugs or other controlled substances or their imitations are strictly forbidden. Additional Event Rules are attached and incorporated by reference to this agreement.

TRANSPORTATION CONSENT*

I understand that some activities involved in by this camp may require travel to other locations. I understand that all transportation during this youth camp will be provided by camp staff or people designated by them and that all drivers of vehicles will be licensed and over the age of 25. I understand that most transportation will be in privately owned vehicles that are in good condition and considered safe.

STATEMENT OF CONSENT AND RELEASE

I, the undersigned, have read and consent to the rules, guidelines and releases specified in this form.

I have read, understand, and agree to abide by the Event Rules.