Camp THY 2023- Camper Registration

Camp THY 2023 Summer Camp Registration Form.
Disclaimer & Notices

Campers who are 18 years old may apply using the Volunteer tab. CITs will learn the same information and tools provided to counselors to assist counselors with their campers.We appreciate Prompt notification if a camper must cancel. Cancellations before May 31st will received a full refund. Cancellations after June 1st will receive a refund if the campers spot is filled. Except in cases of family emergencies. All campers should be covered by their family policy. While Camp Three Holy Youths & St. Nicholas Church will act as a guarantor, any costs incurred by the Camp in providing required treatment for doctor appointments, prescriptions, etc., will be billed by the parent/ legal guardian. Transportation & Release of Liability Forms will be required of Campers as they are met at St. Nicholas Church and accompanied by counselors/volunteers on their travel to/from Camp THY Activities. Parents are required to notify Camp THY of any travel arrangements one (1) week prior to the 2022 Camping dates. St. Nicholas Church, Camp Three Holy Youths, and its affiliates will NOT be responsible for lost, stolen, or damaged items. St. Nicholas Church, Camp Three Holy Youths, and its affiliates will NOT be held legally liable for any injury, nor will they or their affiliates cover any expenses for lost, stolen, or damaged items. Activities include field sports, swimming, Overnight on-sight camping for some ages, and an overnight/ or daytime off-sight backpacking trip. Although the weather can range from the high 80s to even high 90s throughout the day, the nights can be cold reaching temperatures as low as 40 degrees. It is critical that you pack according to the appropriate conditions. All campers are expected to act in ways according to an Orthodox Christian setting. While all disciplinary action will be taken to attempt a resolution on-site, the Camp Director, and Assistant Camp Director(s) reserves the right to dismiss campers for gross violations of camp rules. Parents will be responsible for arranging and covering costs for their child's early departure. Upon being registered, various links and emails will be readily accessible to parents/legal guardians necessary to prepare yourself and your camper for camp. Please be sure the correct email address is included in the Registration Form and be sure to include our email addresses as safe senders. (ilyanbaalbaki@campthy.com & admin@campthy.com) so correspondence from our office is not marked as spam. St. Nicholas Antiochian Orthodox Church of San Francisco is not liable for any lost or stolen items, and will not cover any expenses including those not covered by the camper's insurance. A separate form must be submitted per every camper including Camper Tuition which must be paid in full 1 week prior to camp. Non-refundable. Payments may be made to any registration officers at your local parish. Checks may be payable to...St. Nicholas Orthodox Church 5200 Diamond Heights Blvd. San Francisco 94131. MEMO Camp THY, DO NOT MAIL CASH. ***** COVID-19 ******* All campers & legal guardians/parents are expected to adhere to all guidelines set forth by Amador County, the State of California, & Camp THY. Failure to do so may result in campers' dismissal. Costs of dismissal will be paid by the parent/legal guardian. Due to the ongoing Covid-19 Pandemic, St. Nicholas' Antiochian Orthodox Church of San Francisco, Camp Three Holy Youths, & their volunteers cannot be held responsible for increased risk to Covid-19 Exposure. St. Nicholas Church & its affiliates will not be liable for any illness-induced through this event. Attendance of this event is at the risk of the Attendee & the Attendee ONLY. Guidelines to be enforced may include but are not limited to.... daily health screenings & temperature checks, enforced face masks & social distancing protocols, and so on.
Camper 1 Information
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade Entering at the Time of Camp*
Gender*

MaleFemale
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the camper prescribed any medications? If yes, please explain any instructions. *** NOTE: A SEPERATE MEDICAL FORM IS TO BE COMPLETED BY A MEDICAL PROFESSIONAL & SUBMITTED ONLINE****
Camper 2 Information (Only if Applicable)
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
Grade Entering at the Time of Camp
Gender

MaleFemale
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed any medications? If yes, please explain any instructions. *** NOTE: A SEPERATE MEDICAL FORM IS TO BE COMPLETED BY A MEDICAL PROFESSIONAL & SUBMITTED ONLINE***
Camper 3 Information (Only if Applicable)
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
Grade Entering at the Time of Camp
Gender

MaleFemale
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed any medications? If yes, please explain any instructions. *** NOTE: A SEPERATE MEDICAL FORM IS TO BE COMPLETED BY A MEDICAL PROFESSIONAL & SUBMITTED ONLINE***
Parent/Guardian Information (1)
Name*

First NameLast Name
Home Number

Area CodePhone Number
Cell Number*

Area CodePhone Number
E-mail*
example@example.com
Parent/Guardian Information (2)
Name*

First NameLast Name
Home Number

Area CodePhone Number
Cell Number*

Area CodePhone Number
E-mail*
Emergency Information (1)
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Emergency Information (2)
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number

Parish Information & Releases
Parish Information (Parish, City, State)*
Parish Denomination (Catholic, Orthodox, Maronite)
Parish Priest Information (Name, & Phone #)*
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Camp Three Holy Youths, St. Nicholas Church & It's affiliates during the selected camp. In exchange for the acceptance of said child’s candidacy by Camp Three Holy Youths, St. Nicholas Church & it's affiliates. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Camp Three Holy Youths, St. Nicholas Church & it's affiliates, 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 selected camp sessions.

In case of injury to said child, I hereby waive all claims against Camp Three Holy Youths, St. Nicholas Church & it's affiliates, including all coaches 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 sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

As Parent and/or Guardian of the named athlete, 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 the {Organization} . and its affiliates including Directors, Clergy, Staff, Volunteers, and Counselors to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

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.

A seperate Medical Form is to be submitted via email to admin@campthy.com with camper's medical information. Please Subject the email with camper's name & Medical Form.
Media Release & Consent Authorization

Throughout your stay at Three Holy Youths Camp, staff members and Volunteers will be photographing campers during their experience at camp. However, it will also be used for purposes of promoting Three Holy Youths Camp, St. Nicholas Church and its programs.

During each session, the staff will be taking photographs of the participants' activities and posting them on Facebook, and online websites through various Northern California Diocesan Groups. This common practice of many programs keeps parents and friends back home informed of the participant's' daily activities. Only participants’ first names (not last names) will be used on both Facebook and the website.

Please read the following carefully.

I understand that it is the intention of Three Holy Youths Camp, St. Nicholas Church program to have my participation in the program recorded on videotape and in photographs which may be posted on the program's website, used in camp session videos, and used in publicity materials.

I expressly agree to and grant Three Holy Youths Camp, St. Nicholas Church the right and authority to videotape and photograph my activities and to use any recording of my participation in the aforementioned program in any and all media. Such recordings and photographs become the sole property of Three Holy Youths Camp, St. Nicholas Church.

I give permission for the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of me during camp to be used in the camp video, on the camp website, for promotional purposes of the camp, or shown as Three Holy Youths Camp, St. Nicholas Church sees fit; in perpetuity.

All campers & legal guardians/parents are expected to adhere to all guidelines set forth by Amador County, the State of California, & Camp THY. Failure to do so may result in campers' dismissal. Costs of dismissal will be paid by the parent/legal guardian. Due to the ongoing Covid-19 Pandemic, St. Nicholas' Antiochian Orthodox Church of San Francisco, Camp Three Holy Youths, & their volunteers cannot be held responsible for increased risk to Covid-19 Exposure. St. Nicholas Church & its affiliates will not be liable for any illness-induced through this event. Attendance of this event is at the risk of the Attendee & the Attendee ONLY. Guidelines to be enforced may include but are not limited to.... daily health screenings & temperature checks, enforced face masks & social distancing protocols, and so on.

Signing this Form Accepts Covid Exposure & Releases St. Nicholas Antiochian Orthodox Church, Camp Three Holy Youths, and their Affiliates from liability.
Release & Form Signature Name (Must be 18+)
Email of Registrant or Camper (Must be 18+)

ONLINE PAYMENT FORM

This section is for those who would like to pay online, and online ONLY.
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
PLEASE READ CAREFULLY.

Online Payment is optional, the Camper's Legal Guardian may pay in person, or via Check. If paying by check, please mail to St. Nicholas Antiochian Orthodox Church of San Francisco, 5200 Diamond Heights Blvd, San Francisco CA, 94131.

Please address to St. Nicholas Church Memo Camp THY. DO NOT MAIL CASH.

For Online Payment, select the quantity based on the number of campers you would like to pay for. This form only accepts up to three payments for 3 campers. Online Processing & Card Fees (2.9%) are to be paid by the Camper's Legal Guardian.

There is a $50.00 discount when paying for 3 campers, that option is s from single and dual camper payments.

To Pay, make sure you check the box to the left of the Camper Registration and click on the drop-down menu to select the number of campers.

Transportation is available for those who wish to depart from St. Nicholas Church to Camp St. Sava at an additional rate of $15.00 per camper.

Finally, please use the electronic signature to verify your online payment.

For any questions on your form, please contact Subdeacon Ilyan Baalbaki for further assistance.

Camp Tuitions

Camper Registration$309.00

Single Camper Tuition (Max of 2 Camper's)

Quantity
Item subtotal:$0.00

3 Camper Tuition$772.10

Discounted Tuition for 3 Campers.

Camper Transportation (St. Nicholas - Camp St. Sava)$31.15

Quantity
Item subtotal:$0.00

Total $0.00

Credit Card

Signature

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Camp THY 2023 Summer Camp Registration Form.

Disclaimer & Notices

Parish Information & Releases

ONLINE PAYMENT FORM

Credit Card