Camp Good News Registration

Camper Information

Camper's Name*

First NameLast Name

Birth Date*

MonthDayYear

Age*

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Church

Parent/Guardian Information

Name*

First NameLast Name

Home Number

Area CodePhone Number

Cell Number*

Area CodePhone Number

E-mail*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Insurance Provider *

Policy Number *

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed an inhaler? If yes, please explain any instructions.

CAMP FEE: $85 DUE BY JULY 1st 2023.

Please make checks payable to: CEF of Tennessee Valley

Please mail your payment to: CEF Of Tennessee Valley
PO Box 1231
Decherd, TN 37324

OR: Submit payment to the partnering church of which your child will be coming with.

THE ATTACHED RELEASE FORM MUST BE PRINTED, SIGNED AND RETURNED ALONG WITH THE CAMP FEE IN ORDER FOR YOUR CHILD TO ATTEND CAMP GOOD NEWS.

SCHOLARSHIP APPLICATION
Deadline for Scholarship Application is May 1st, 2022

Are you in need of a Camp Scholarship?*

YesNo

If you are need of a Camp Scholarship, please identify the reason(s) for the need.

More than one child attending campLow Income

If you are in need of a Camp Scholarship, please explain in detail the reason(s) for the need.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by CEF of Tennessee Valley during Camp Good News. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless CEF of Tennessee Valley, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from camp.

In case of injury to said child, I hereby waive all claims against CEF of Tennessee Valley, including all volunteers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all camp activities.

Does CEF of Tennessee Valley have permission to use your child's photo for promotional purposes?*

YesNo

Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to CEF of Tennessee Valley, and its affiliates to provide the needed emergency treatment prior to the child’s admission to the medical facility.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

All medicines must be turned in to the Camp Nurse upon check-in.

ADDITIONAL INFO

Camp Check-In begins at 4:00 p.m. on July 9th at Camp Rain, located at:
626 Bennet Cemetery Road
Decherd, TN.

The signing Parent or Guardian must be with the child at Check-In unless the child is coming with a partnering church, in which case, check-in will take place at the location of the partnering church at a predetermied time to be announced.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

A letter will be mailed to you a few weeks prior to camp with a checklist of what each camper will need to bring to camp.

Coupon Code:

Camp Good News Registration

Medical Information