Institute Summer Camps 2020

Institute Summer Camps

ONE FORM PER CHILD
This is my registration for *

Green Lake YOUNG MEN (ages 14-17) Monday, June 7 - Friday, June 11 Green Lake YOUNG LADIES (ages 14-17) Monday, July 5 - Friday, July 9 Wausau BOYS (ages 9-13) Monday, July 12 - Friday, July 16 Wausau GIRLS (ages 9-13) Monday, July 19 - Friday, July 23

Institute Summer Camps

ONE FORM PER CHILD
Participant Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
Age on the first day of camp *
Local Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Best Phone Number to Reach You *

Area Code Phone
Email (Do not provide a minor’s email if you do not permit its use by the Institute.) *
example@example.com
Special Needs and /or Considerations (Such as Food Allergies, Other Allergies, Medical Conditions, Special Needs, Handicaps, and/or Limitations, Prescription Medications – Important Note: All prescription medications must be disclosed!
Medical/Allergic Dietary Needs:
Green Lake Conference Center will provide alternative meals to guests with medical or allergic dietary needs such as nut allergies, celiac disease, lactose intolerance, etc. Food is cooked separately to avoid cross contamination when necessary. Medical/allergic dietary needs must be communicated 2 weeks prior to arrival by filling out the Medical/Allergic Dietary Request Form. This form is for medical/allergic dietary needs only (not for dietary preferences). You will be contacted the week before your arrival regarding your meal accommodations.
Special Needs and/or Considerations

Please contact me (parent/guardian) regarding any special considerations listed in this section
Summer Camps 2021

Institute Policies and Procedures
Supervision of Minors

Institute activities involving minors must meet the following standards:
- All members, staff and adult volunteers who supervise minors must be in compliance with the safe environment requirements of their respective (Arch)diocese.
- No fewer than two adult supervisors must be present at all Institute activities involving minors (including transportation to and from Institute activities); more supervision might be necessary to meet adult:child ratios for a specific event, to be determined by the Institute member who is in charge of the event.
- Under no circumstances may a minor be placed in a supervisory role over other minors. It is the responsibility of adults to properly supervise the minors in their care.
Overnight Accommodations:

Institute activities that include overnight stays must meet the following standards:
- Members, staff, and adult volunteers may not share bedrooms with other Members, staff, adult volunteers, and adult clients. On trips or retreats away from permanent Institute locations, if separate accommodations cannot be provided due to group size or limited availability, then an exception may be made to this policy if (a) the provincial superior approves the accommodations in advance; and (b) the alternative accommodations do not mix males and females (except for married couples).
- For Institute activities that include overnight stays with minors, members, staff, and adult volunteers may not share bedrooms with minors including but not limited to, bedrooms in any Church owned facility, private residence, hotel room, or any other place. Where separate accommodations cannot be provided due to group size or limited availability, then an exception may be made to this policy if the following three criteria are met: (a) the provincial superior approves the accommodations in advance; (b) the alternative accommodations do not mix males and females; and (c) the rule pertaining to “Two Adults at All Times,” above, remains in force.
Photo Use Policy:

As an integral part of its mission, the Institute may take or acquire photographs that communicate news about the implementation of it mission and vision. These photographs may be routinely published in printed and digital publications and training materials, and/or on its website or other social media platforms. The Institute is committed to the responsible use of these photographs. Under no circumstances will the Institute knowingly publish photographs that could be an embarrassment, cause scandal, or bring discredit to the Institute or the individuals in any photograph. Neither full names nor contact information will be published alongside any photographed adult without the individual’s prior written consent, and no image of an individual will be used in any fundraising appeal without that individual’s prior written consent. Attribution credit will be given when required by applicable copyright laws. As a courtesy, and to the extent possible, the Institute will decline to use an image, or will promptly remove an image, upon request. In some circumstances, however, it may be impossible to accommodate such a request, as for example when the image is of a large group at a public event.

By permitting a minor to participate in the Institute’s public events, such as Masses, Baptisms, Confirmations, performances, community outreach projects, and similar events, parents and guardians will be deemed to have consented to the Institute’s policy. For private events, parents and guardians will be asked to provide written permission for the use of the minor’s image in a manner consistent with this policy at those events.

Email and Texting Policies for Minors:

Members, staff, and adult volunteers who wish to conduct text, email or online conversations with minors age 13 or below must do so only through their parent’s accounts. Members, staff, and adult volunteers who wish to conduct text, email or online conversations with minors age 14-17 must copy the minor’s parent or guardian on all such communications.

Also note that any Institute employee or adult volunteer who receives a "friend request" on his personal social media account from a minor affiliated with the Institute is required by Institute policy to reject the request, unless specific permission is granted by the superior and the individual’s parent or guardian. Similarly, members of the Institute may not use any personal social media accounts in their work for the Institute; members may only use social media accounts owned by the Institute itself.
Policy *

I have read the policy and will abide by it.

Institute Summer Camps

ONE FORM PER CHILD
Information for Camper
Health Insurance Information
Name of Insured
Health Insurance Provider
Insurance Company
Policy Number
Emergency Contact Information
Primary Contact Name

First Name Last Name
Primary Contact Relationship to Participant
Relationship
Primary Contact Phone Number(s)
Primary Contact Email
example@example.com
Secondary Contact Name

First Name Last Name
Secondary Contact Relationship to Participant
Relationship
Secondary Contact Phone Number(s)
Secondary Contact Email
example@example.com
Release and Waiver of Liability Agreement
The participant desires to participate in "Institute Summer Camps", sponsored by the Institute of Christ The King Sovereign Priest (“Institute”). This Release and Waiver of Liability Agreement covers the entirety of my participation in the Summer Camps, including travel in order to participate in activities associated with the camps.

1. Risk Factors: The undersigned understands and acknowledges that the use of equipment and facilities provided by the Institute in participation in the Institute Summer Camps involves risks including, but not limited to the following: risk of property damage, bodily injury, including, but not limited to permanent disability, paralysis, and possibly death. These risks may result from a variety of circumstances including, but not limited to, the use or misuse of equipment or facilities, from the activity itself, from the acts of myself or others, including the Institute and its agents or from the unavailability of emergency medical care.

2. Assumption of Risk: The undersigned assumes full responsibility for all risks that may arise out of or may result from participation in the Institute Summer Camps, including but not limited to, those risks described in Section 1, above. Except from this section are any injuries caused by the gross negligence or willful or wanton misconduct of any officials, officers, employees, agents, or volunteers of the Institute.

3. Acknowledgment of Policies and Procedures: The undersigned acknowledges that I have read, know, and agree to all of the policies and procedures relating to my participation in the Institute Summer Camps. The undersigned understand that the safe and proper use of all facilities, equipment or participation in the activity is dependent upon carefully following these policies and procedures. The undersigned agrees to comply with and abide by all rules, regulations and policies of the Institute Summer Camps. The undersigned understand that the Institute reserves the right to revoke or terminate participation in the Institute Summer Camps for any violations of these rules, regulations, or policies, or for any misbehavior.

4. Release, Indemnify, and Defend: The undersigned hereby releases, waives, discharges and holds harmless the Institute, and all of their affiliates, predecessors, successors, trustees, officers, directors, faculty, employees, agents, and representatives, past or present ( hereinafter jointly referred to as “the released parties”) from any and all claims, suits, liabilities, judgments, costs, and expenses (“claims”) for any property damage, property loss or theft, personal injury or illness, death or other loss arising from or relating to participation in the Institute Summer Camps. The undersigned also agrees to defend, indemnify, and hold harmless the Released Parties from and against any claims arising from or related to the undersigned’s own acts or omissions in connection with participation in the Institute Summer Camps.

5. Photography Consent. The undersigned consents to the use of the participant’s image in a manner consistent with the Institute’s Photo Use Policy.

6. Payment for Damages: The undersigned agrees to pay for any and all damages to any property or Released Party caused by the undersigned, negligently, willfully or otherwise.

7. Consent for Emergency Treatment: The undersigned consents to medical treatment for emergencies that occur during or are related to participation in the Institute Summer Camps where the undersigned is unable to consent to such treatment. The undersigned understands that the provisions of this Release and Waiver of Liability Agreement apply to any treatment that might be provided to me under any of these sections within this agreement.

8. Insurance: The undersigned understands that I am solely responsible for any medical, health or personal injury costs relating to my participation in the Institute Summer Camps. The undersigned understands that I am strongly encouraged to have a medical physical examination and purchase health insurance prior to any and all participation in the MFL.

9. Jurisdiction: This Release and Waiver of Liability Agreement shall be governed in all respects by the laws of the State of Illinois (Institute Headquarters in Chicago, Illinois). The parties agree to use the State of Illinois for jurisdiction for any disputes between the parties related to this Release and Waiver of Liability Agreement.

10. Severability: If any term or provision of this Release and Waiver of Liability Agreement is held to be illegal, invalid, or unenforceable, or the application thereof to any person or circumstance shall to any extent be illegal, invalid or unenforceable, under present or future laws effective during the terms hereof or of any provisions hereof which survive termination, then in any such event, it is the express intention of the parties that the remainder of this Release and Waiver of Liability Agreement, or the application of such term, clause or provision other than to those as to which it is held illegal, invalid or unenforceable, shall not be affected thereby, and each term, clause or provision of this Release and Waiver of Liability Agreement and the application thereof, shall be legal, valid and enforceable to the fullest extent permitted by law.

The undersigned has read and fully understands this Release and Waiver of Liability Agreement and understands that it relates to surrendering and releasing valuable legal rights. The undersigned does so freely and voluntarily.
Consent and Release on Behalf of Minor by Parent/Legal Guardian

I am the parent or legal guardian of the above named minor. I have read and understand this Release and Waiver of Liability Agreement in its entirety and understand that it relates to surrendering valuable legal rights of the minor and myself. I agree to be bound by all the terms of the Release and Waiver of Liability Agreement. I also give my consent to the participation in the Institute Summer Camps of the minor.
Name of Parent or Legal Guardian Signing This Form *

First Name Last Name
Parent or Legal Guardian E-Signature *

Clear
For signature above use curser (or finger if using tablet or phone) to electronicly sign in the box on the black line.
Date Signed *

Month Day Year
Date

Institute Summer Camps

ONE FORM PER CHILD
My Payment
I would like to pay *

Online Payment (PayPal Credit Card, Credit or Debit Card) Check, Money Order, Cash

Institute Summer Camps

ONE FORM PER CHILD
Online Payment:

One submission per participant
Cost per participant
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GREEN LAKE CAMP (ages 14-17) discounted rates Free

Nb of children attending ANY Institute Camp this summer:

WAUSAU CAMP (ages 9-13) flat rate $ 95.00

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00
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Please note, upon registration, payments taken are considered final, and will not be refunded in the event you are unable to attend.

For further information please contact:

Green Lake Young Men Camp (14-17) Monday, June 7 - Friday, June 11	campmichael@institute-christ-king.org
Green Lake Young Ladies Camp (14-17) Monday, July 5 - Friday, July 9	campimmaculate@institute-christ-king.org
Wausau Boys Camp (9-13) Monday, July 12 - Friday, July 16	campsavio@institute-christ-king.org
Wausau Girls Camp (9-13) Monday, July 19 - Friday, July 23	camptherese@institute-christ-king.org

Institute Summer Camps

ONE FORM PER CHILD
Other forms of Payments:

One submission per participant
My payment *

I hereby acknowledge that payment should be received on the FIRST DAY OF CAMP
GREEN LAKE (ages 14-17: discounted rates/per child according to the number of children that will be participating in ANY Institute camp this summer)

1 CHILD: $195 2 CHILDREN: $155 per child 3 CHILDREN: $135 per child 4 or more CHILDREN: $125 per child
WAUSAU (ages 9-13: flat rate)

$95 per CHILD
I am sending my payment now (check, money order, cash) to

"Institute Christ the King" - 6415 South Woodlawn Ave, 60637 Chicago Illinois - Memo: Summer Camp registration

Please note, upon registration, payments taken are considered final, and will not be refunded in the event you are unable to attend.

For further information please contact:

Green Lake Teen Boys Camp (14-17) Monday, June 7 - Friday, June 11	campmichael@institute-christ-king.org
Green Lake Teen Girls Camp (14-17) Monday, July 5 - Friday, July 9	campimmaculate@institute-christ-king.org
Wausau Young Boys Camp (9-13) Monday, July 12 - Friday, July 16	campsavio@institute-christ-king.org
Wausau Young Girls Camp (9-13) Monday, July 19 - Friday, July 23	camptherese@institute-christ-king.org

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Institute Summer Camps

Institute Summer Camps

Summer Camps 2021

Institute Summer Camps

Information for Camper

Health Insurance Information

Emergency Contact Information

Release and Waiver of Liability Agreement

Institute Summer Camps

Institute Summer Camps

Institute Summer Camps