All payments will be submitted to Christ Place Church. Contact Christ Place after submitting your registration to complete payment.
Grades are based on the grade campers are entering in the Fall 2021 school year.
After reading this entire form and the Camp Policies and Procedures, I hereby give permission for my child to attend an NSM Camp in 2021.
I further certify that the medical history is correct as far as I know. I acknowledge that in the event of an emergency every effort to contact me and my emergency contact will be made, with that in mind, Nebraska Student Ministries, its agents, and employees have permission to transport my child to such a physician and/or hospital as they may select, and to authorize and secure hospitalization, treatment, surgery, and/or medications for my child as they or the health care professionals involved may deem necessary for my child’s well being. I agree to hold harmless Nebraska Youth Ministries, its agents, and employees, with respect hereto.
I allow my student to participate in camp recreational activates including but not limited to: Playground, Mud-Pit, Various field games (splash kickball, soccer, flag football, etc.), Dodge Ball, Basketball, Indoor swimming pool, Go-Carts, Gyro, Sand Volleyball.
I also understand that participants at The Crossing Retreat Center are liable for damage caused intentionally or maliciously. Damage caused by a participant will be billed directly to the participant responsable and their legal guardian.
I have reviewed the camp dress policies with my child. DRESS POLICY: Only appropriate and modest clothing is permitted. No clothing portraying indecent, suggestive, or profane writing, pictures, or slogans. No shirts that show midriff or the sides of your torso whether male or female. Ladies: Bra straps/bralettes should be covered. Leggings should be worn with tops that cover to the mid-thigh. Shorts and skirts should be mid-thigh length. A camper/leader may be asked to change at the discretion of camp staff.
I understand that every effort will be made to room church groups in the same cabins. However, due to the structure of the camp and the limited number of beds, this is not always possible.
I give permission to Nebraska District Assemblies of God to use photographs (individual or group) and/or multimedia images and recordings in the best interest of Nebraska District Assemblies of God.
Medical Release I give my consent for the director or properly appointed staff member of Nebraska Student Ministries to secure the administration of medical treatment or medication for myself/my child in case of emergency, and I do further agree to the performance of such treatment, anesthetics and operations, as in the opinion of the attending physician, is deemed necessary for myself/my child.
Applicant Statement The information contained in this application is correct to the best of my knowledge. I authorize references and churches listed in this application to give you any information they may have regarding my character and ﬁtness for children/youth work. I release all such references from liability for any damage that may result from furnishing such evaluations to you. Should my application be accepted, I agree to be bound by the Constitution and Bylaws and policies of the Nebraska District Council. I will refrain from unscriptural conduct in the performance of my services on behalf of my church. I agree to read the Camp Staff Manual. I understand, agree with, and am willing to abide by the expectations for staff set by the Nebraska District Council of the Assemblies of God.
I also agree to have my Pastor contacted for a reference regarding my character and suitability for children/ youth work. I waive any right that I may have to inspect references provided on my behalf.
Dress Policy Only appropriate and modest clothing is permitted. No clothing portraying indecent, suggestive, or profane writing, pictures, or slogans. No shirts that show midriff or the sides of your torso whether male or female. Ladies: Bra straps/bralettes should be covered. Leggings should be worn with tops that cover to the mid-thigh. Shorts and skirts should be mid-thigh length. A camper/leader may be asked to change at the discretion of camp staff.
Background Check Authorization I hereby authorize The Nebraska District Council of the Assemblies of God to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications to work with children, youth, and others. I release the Nebraska District Assemblies of God and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used.