FOURSQUARE KIDS CAMP 2023

Price: $195
Age: INCOMING 4th – 6th grade
Drop off: 4p Friday, July 21
Pick up: 11a Sunday, July 23
Camp address: 20800 Marine Dr, Stanwood, WA 98292

PACKING LIST

Bible & Pen/Highlighter

Sleeping Bag
Pillow
Shampoo/Soap
Towel
Toothbrush and toothpaste
Bug spray
Water Bottle
Flashlight
Casual clothes
Warm Jacket & sweatshirt
Running Shoes
Plastic bag for dirty clothes
Swimsuit & Towel

DO NOT BRING: ELECTRONICS OF ANY KIND, INCLUDING, TABLETS, KINDLES, IPODS, VIDEO GAMES, RADIOS, PETS, FIREWORKS AND CELL PHONES

Camper Cost $195*

Camper (4th-6th grade)Jr Leader (age 15-17)

Camper's Name: (First)*

(Last)*

Parent/Guardian Email*

example@example.com

Parent/Guardian Cell or Best Phone Number*

Camper's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Gender Please Check:*

FemaleMale

Date of Birth*

Date

Incoming Grade*

ROOMATE REQUEST

Parent/Guardian Name(s)*

Additional Emergency Contact Person*

Relationship*

Additional Emergency Cell Phone*

Jr. Leaders only: CPR Certified? (not required)

IF CERTIFIED PLEASE PROVIDE A COPY

Church coming with*

T-SHIRT SIZE

Signature*

Clear

Date

Name*

First NameLast Name

Church coming with*

Date of Birth*

Date

Age*

Church Leaders Name

Emergency Contact*

Name

Phone Number*

Please enter a valid phone number.

Relationship to you*

Non-Family Contact*

Name

Phone Number*

Please enter a valid phone number.

Legal Guardians*

Name

Parenting Plan in place?*

I AUTHORIZE CAMP STAFF TO GIVE THE FOLLOWING TO MY CHILD AS NEEDED AT CAMP:
Antacids, acetaminophen, antibiotic ointment, antihistamine, allergy eye drops, Benadryl cream, cough drops, calamine lotion, hydrocortisone cream, ibuprofen, Sudafed PE

Signature*

Clear

Date*

Date

ARE THERE ANY ALLERGIES TO THE FOLLOWING? IF YES PLEASE DESCRIBE IN DETAIL.*

YESNO

FOODS?*

Put None or NA please do not leave blank

EpiPen Needed?*

YesNo

Medications?

Put None or NA please do not leave blank

Environmental Allergen(s)?

Put None or NA please do not leave blank

Inhaler Needed?*

YesNo

EpiPen Needed?*

YesNo

Any other Special Medical Concerns or Needs? Please Describe*

Put None or NA please do not leave blank

Some medical conditions require pre-approval to attend camp, discuss with your childrens pastor

Write the name of medication and/or vitamin supplement your camper or Jr. Leader is/are taking and fill in directions below.
Camp will have Registered Nurses onsite.
It is not necessary to send any pain relievers, Neosporin, or generic allergy medications to camp.
DO NOT send loose meds or vitamins – Campers may not take. Must be in original bottles. NO EXCEPTIONS!!!

(DO NOT write in “DAY” columns!!! To be filled out by medical staff)

	Medication or Vitamin Name	Directions & Frequency	FRI	SAT	SUN
1
2
3
4
5

JULY 21-23 2023

Activity Permission, Release, & Medical Power of Attorney

1.I,{parentguardianNames}the lawful parent or guardian of {campersName}{last7}, give permission for my child to participate in the activity of Foursquare Kids camp located at Warm Beach Camp, 20800 Marine Dr, Stanwood, WA 98292 and release, from all liability and indemnify the International Church of the Foursquare Gospel: MARYSVILLE FOURSQUARE CHURCH, and its directors, officers, council, agents, representatives,volunteers, and employees ("M4CHURCH") from any and all liability, claims, judgments, cost or expense, including attorney fees, arising out of any damage, injury or illness incurred or caused by my child while participating in or traveling to or from the activity, or otherwise in camp custody. I understand the risks in these activities, including the possibility of unforeseen hazards, serious injury or death. I certify my child is able to participate in the activity.

2.I agree to instruct my child to cooperate with the camp and its representatives in charge of the activity and understand my child may be prohibited from participating and or sent home for any failure to follow the rules established by the MARYSVILLE FOURSQUARE CHURCH and Warm Beach Camp.

3. I appoint MARYSVILLE FOURSQUARE CHURCH representatives who are acting as leaders, or designated by such leaders as my attorney in fact to act for me in my name and my behalf, in any way that I could act if were personally present with respect to the following matters if any injury, illness or medical emergency occurs during the activity, related travel or while my child is in camp custody.

A. To give any and all consents and authorization to any physician, dentist, hospital or other persons or institutions pertaining to any emergency actions as our medical attorney in fact shall deem necessary or appropriate for the best interest of the child.

B. I understand the M4CHURCH will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child.

4. I agree that the M4CHURCH may use my child's and or my own name, voice, portrait, photograph or image for promotional website, office or any other district related purpose. These may be used in any broadcast, telecast, digital or print medium, including video images, photographs, pictures or renderings, audio recordings, or other likenesses, in combination or alone.

5. My child is to be EXCLUDED from the following activities

and/or EXCLUDED from release to the following Person(s)

I will notify the church immediately of any change in the information presented and agree it is valid until revoked in writing by me. I have carefully read this statement, and my signature acknowledges that I fully understand the content and meaning.

Signature of Parent or Guardian*

Clear

Date*

Date

WAIVER AND RELEASE FROM LIABILITY
(TO BE COMPLETED BY PARTICIPANT)

This agreement is made this day {date}, 2023 between Warm Beach Camp and
{parentguardianNames41}("Participant")

Subject. Participant recognizes and expressly agrees that participating in any adventure, sport or activity associated with the out-of-doors is an inherently dangerous activity. Further, Participant recognizes that certain safety precautions must be followed, yet even strict adherence to those procedures does not guarantee nor does Warm Beach Camp guarantee Participant's safety.

Waiver and Release from Liability. Participant understands that Warm Beach Camp assumes no responsibility for injuries or illnesses that Participant may sustain, a) as a result of Participant's physical condition, b) resulting from Participant's participation in the activity, c) as a result of another participant's or third person's actions, or d) as a result of participant's use of Warm Beach Camp facilities, field, and/or equipment in connection with this activity.
The Participant releases and agrees to hold harmless, defend and indemnify Warm Beach Camp and it directors, officers, employees and agents from and against any and all claims for personal injury (including loss of life) and all other losses or damages (except those caused entirely by the gross negligence or intentional conduct of Warm Beach Camp) that the Participant may suffer as a result of his or her participation and /or enrollment in Warm Beach Camp activities.

Medical Consent. Participant grants permission to Warm Beach Camp and its employees and agents to take the Participant to a licensed physician for medical treatment, emergency surgery, or hospitalization if Participant becomes ill, sustains an injury, or otherwise requires medical treatment or attention and Warm Beach Camp is unable to contact the Emergency Contact listed by Participant. The Participant gives consent to any licensed physician to administer drugs or medicine or to perform such medical procedures as that physician determines necessary for the relief of pain and to preserve the Participant's life or health. Participant further authorizes Warm Beach Camp to give first aid, CPR or other treatment by a qualified staff member to Participant.

Property Loss. Participant understands and agrees that Warm Beach Camp is not responsible for personal property that is lost, damaged, or stolen in connection with this activity.

Binding Effect. This Agreement shall be binding upon Participant, his or her heirs, estate, successors, and legal representatives.

Entire Agreement. This Agreement represents the entire agreement between the parties. This Agreement shall not be modified or amended except by an agreement in writing signed by both parties.

Acceptance. If any portions of this waiver and release are held to be invalid, Participant agrees the remaining terms shall continue to be in full legal force and effect. Participant understands and agrees that this Waiver and Release is binding upon me and my heirs, estates and legal representatives.

Publicity. On Occasion, Warm Beach Camp takes photographs or makes an audio or video tape recording of children and/or adults involved in camp activities. Such photographs and audio/visual recordings may be used in Warm Beach Camp publications or advertising materials to let others know about our ministry. In addition, local news organizations may hear about our activities or events, and Warm Beach Camp may invite or allow them to photograph or record our events for news reporting on special interest features. Participant agrees to the use of any such audio or visual recordings to be used, distributed or displayed as agents of Warm Beach Camp see fit. This consent includes but is not limited to: photographs, videotape, and audio recordings.

PLEASE READ CAREFULLY. THIS DOCUMENT CONTAINS A RELEASE AND WAIVER OF LIABILITY.
I have read and voluntarily signed this Waiver and Release of Liability.