Camp Elim Release and Understanding 2022

Camp Elim Release and Understanding 2022

You must be 18 years of age or older to fill out this form. One form per family (separate families must use separate forms)
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
Allergy/Dietary?
Denote a severe allergy with an asterisk (E.g. *Peanuts)
Allergy Severity

Is Life ThreateningIs Airborne
Please mark the severe allergies with an asterisk(*) above.
Other family members to add to this release?

Add other family members
List all family members coming with you to Camp*
Please provide an emergency contact for your family. This should be someone not coming to Camp with you who we can contact in the event you are unavailable.
Emergency Contact*

First NameLast Name
Emergency Contact Phone*

Area CodePhone Number

Emergency Release and Understanding

Indicate your consent to each item below by initialing the provided space then provide an emergency contact not at Camp with you.
Activities Release
I, First Name* Last Name*, hereby acknowledge my willful decision to attend Camp Elim and to participate in all activities. I will not hold Camp Elim or its agents liable for injury caused by common accident, illness (including COVID-19 and any of its variants) or the rendering of emergency care. I give permission for my family members named on this form to participate in any off-site activities during camp and to be transported to and from these activities, including emergency situations (if any) by authorized vehicles.
Initial*
Medical Release
I, First Name* Last Name*, understand that in the event of an emergency, every effort will be made to contact a responsible relative of the camper. In the event that contact cannot be made, I hereby give permission to the camp administration and the physician they may select to secure proper treatment for, to hospitalize, and to order such injections, anesthesia or operations as may be urgently necessary for myself and my family members named on this form. In the event of a claim, family insurance (if any) will be billed. Camp Elim’s insurance provides secondary coverage for injuries sustained at Camp.
Initial*
I give permission to Camp Elim to use video or photography of me or my family members for promotional purposes*

YesNo
Please note any media exceptions to the above:
Signature

By signing I agree to the statements in this form Clear
Typed Signature*
Type your legal name signature as written above
Should be Empty:

Camp Elim Release and Understanding 2022

Emergency Release and Understanding