Adventure Camp Registration

Adventure Camp Registration
Parent's Information:*

First NameLast Name
Email:*
example@example.com
Phone Number:*
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Address:*

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Child's Information:*

First NameLast Name
Gender:*

MaleFemale
Date of birth:*

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Height:
Weight:
Grade:
Do you have health insurance for your child?*

YesNo
Describe any behavioral issues and/or medical conditions that your child has had in the past 5 years:*
By signing below, I am requesting that New Song Mission, Inc. enroll my child in its Summer Adventure Camp.*

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NEW SONG MISSION, INC.
(D/B/A New Song Adventure Camp)

Release of Liability, Waiver, Indemnification, and Consent To Medical Treatment

New Song Mission, Inc. (“New Song”) is pleased to offer summer Adventure Camp weeks on its Brown County, Indiana campus. I understand that all day camp, overnight camp, and other recreational programs carry with them significant risks. Although New Song has taken reasonable and prudent steps to reduce foreseeable risks, dangers still exist. In exchange for my child or children (hereafter referred to as “Child”), the names of which are listed below, being allowed to participate in a day or overnight camp (hereinafter referred to as “Camp”) or recreational program or activity (hereafter referred to as the "Program") sponsored by New Song, I agree to be bound by each of the terms, conditions, and permissions listed below.

1.       Voluntary Participation. I understand and confirm that my Child’s participation in the Program is voluntary.

2.       Identification of Risks. I understand that there are certain dangers, hazards, and risks inherent in day camp, overnight camp, and other recreational activities, including foreseeable and unforeseeable risks. More specifically, there are certain dangers, hazards, and risks inherent in certain activities conducted at the Program, including, but not limited to, climbing walls, inflatables, water games and events, and outdoor games, swimming, horseback riding, rafting, canoeing, paintball, extreme sports, high adventure activities, rock climbing, gymnasium activities, sports, zip line, low ropes course, rappelling, and camp transportation (hereafter referred to as Recreation Activities), sleeping in tents, cabins, or houses, bathing and eating and other residential activities , all of which are regularly scheduled Program activities. I also understand that there are risks posed by wildlife such as snake and insect bites, including tick bites which can infect campers with Lyme Disease, causing harmful, lifelong health issues if left untreated. Furthermore, my child’s participation in the Program may result in the exposure to other certain risks including exposure to coronavirus (COVID-19), other biological agents, communicable diseases, viruses or similar bacteriological agents (hereinafter referred to as the “Risks”).

I hereby give permission for my Child to participate in Adventure Camp and all of its Program activities, understanding that there are known risks like those mentioned above and other unknown risks and dangers involved. I also understand that medical facilities or treatment may be inadequate or unavailable during portions of the Program. I understand that my Child’s participation in the Program may involve risk of injury and loss, both to person and to property, and that this risk of injury and loss may include the possibility of serious bodily injury, permanent disability, and death of my child. I understand that there may be other risks not known to New Song and not reasonably foreseeable at this time. I further understand that some of the premises, facilities, and equipment used in connection with the Program may not be owned, maintained, or controlled by New Song, but rather by the premises owners (the "Premises Owners").

I understand that this Release of Liability, Waiver, Indemnification, and Consent To Medical Treatment is intended to address all of the risks of any kind associated with my Child’s participation in any aspect of the Program, including, particularly, such risks involving Recreation Activities, as well as risks created by actions, inactions, or negligence on the part of New Song or its directors, officers, employees, agents, volunteers, successors, or assigns (collectively, the "Representatives"), including, but not limited to, risks created by the following: (a) inadequate or negligent programming and/or supervision; (b) poor conditions of premises on which various Program events occur; (c) the lack or inadequacy of policies, rules, or regulations with respect to the Program; (d) the failure of New Song or its Representatives to foresee or protect my child from actions, inactions, negligence, recklessness, or intentional or criminal misconduct of other persons; (e) the inadequacy or unavailability of medical facilities, treatment, and/or professionals; or(f) the lack or inadequacy of supervision by New Song or its Representatives.

1.       Assumption of Risk. I assume all risks, known and unknown, foreseeable and unforeseeable, in any way connected with my Child’s participation in the Program, including all of its Recreation Activities, those referred in this document and those not specifically referred to. I accept personal responsibility for any liability, personal injury, or economic or noneconomic damages or loss in any way connected with my Child’s participation in the Program, including its recreational activities. I represent to New Song that I have health insurance that is adequate to cover treatment for any personal injuries my child may sustain as a result of my participation in the Program, including its Recreational Activities.

2.       Release and Waiver. I release New Song and its Representatives (including Staff Members, Board Members, Volunteers, and others associated with New Song) to the fullest extent permitted by applicable law from any and all liability for, and waive any and all claims for, personal injury or economic or noneconomic damages or loss, including attorneys' fees, in any way connected with my Child’s participation in the Program, including its recreational activities, even if caused in whole or in part by the negligent acts or omissions or other misconduct of New Song or any of its Representatives (a "Claim"). This release does not apply to reckless or intentional misconduct of New Song or any of its Representatives. I am aware of MCL 700.5109, which authorizes organizations such as New Song to obtain releases covering a minor's participation in a recreational activity, and I agree that this release is authorized by that statute.

3.       Indemnification. I agree to indemnify and to hold harmless (in other words, to reimburse and to be responsible for) New Song and its Representatives, and the Premises Owners, from any Claim or expense, including reasonable attorneys' fees for the legal counsel of New Song's choice (including the cost of defending any Claim I (or any member of my family) might make, or that might be made on my behalf (or on behalf of any of my family members), that is released or waived by this instrument), in any way connected with a Claim.

4.       Binding Effect. This instrument shall be binding upon my relatives, personal representatives, members, heirs, beneficiaries, next of kin, or assigns and shall inure to the benefit of New
Song, the Program, and the irrespective directors, officers, employees, agents, volunteers, successors, and assigns.

5. Consent to First Aid Treatment. I authorize New Song Mission and its representatives to administer first aid treatment and common over the counter medication such as Tylenol, Ibupophen, and Benadryl to my child as needed. I will inform New Song in writing if my child has adverse reactions (including allergies) to any medications and will provide New Song with any medication that my child regularly takes for allergies or other healthcare conditions in their original packaging with directions for use, and to provide all perscription medicine in their pharmacy containers fully labeled with child's name and date of birth.

6.       Consent to Medical Treatment. I authorize New Song and its Representatives, and the Premises Owners, if present, to provide to my Child, through medical personnel of their choice, customary medical assistance, transportation, and emergency medical services should I require such assistance, transportation, or services as a result of injury or damage related to my participation in the Program. This consent does not impose a duty upon New Song or its Representatives, or upon the Premises Owners, to provide such assistance, transportation, or services.

7.       Severability. If any provision (or portion of any provision) of this instrument is held to be invalid or unenforceable, that provision shall be enforceable in part to the fullest extent permitted by law, and such in validity or unenforceability shall not otherwise affect any other provision of this instrument.

8.       Applicable Law. Because the Program activities all occur and are located in the State of Indiana, and in order to provide certainty in the law to be applied to the construction of this instrument, this instrument shall be governed, construed, and enforced in accordance with the law of the State of Indiana.

THIS IS A RELEASE OF LIABILITY AND WAIVER. I HAVE READ AND UNDERSTAND ALL PARAGRAPHS OF THIS RELEASE OF LIABILITY, WAIVER, INDEMNIFICATION, AND CONSENT. I UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS BY SIGNING IT. I AM SIGNING THIS RELEASE OF LIABILITY, WAIVER, INDEMNIFICATION, AND CONSENT VOLUNTARILY.

In exchange for my Child or Children being allowed to participate in the Camp and Program, and as the parent or legal guardian of the above-named children, I verify that I fully understand, agree to, and accept all provisions of this Release of Liability, Waiver, Indemnification, and Consent To Medical Treatment. I further represent and agree that I am signing on behalf of, and as an agent for, any other individual who may be a parent or guardian of my Child, that I am fully authorized to do so, and that by executing this Release of Liability, Waiver, Indemnification, Consent and Marketing Release Form, I am binding myself, any other parent or guardian of my Child, and my Child.
Printed Name*
Signature*

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MARKETING RELEASE

As parents of a child/children attending the New Song Adventure Camp and Program, and in consideration of the services provided by New Song Mission, Inc., we do hereby grant permission and consent to the participation in interviews, the use of quotes, and the taking of photographs or videos of my/our child by New Song Mission.

I/we also grant New Song Mission the right to edit, use and reuse said products as well as my child’s/children’s first name for non-profit purposes, including print, radio, television, internet, electronic or digital publishing, social media and all other forms of media.

I hereby release New Song Mission and its agents and employees, as well as the mass communication outlet in which the said product was used from all claims, demands, and liabilities whatsoever in connection with the above.

By signing this form, I/we consent for these photos/videos and my child’s/children’s first name to be used in any and all New Song Mission promotions and waive any and all present or future rights to compensation for my child/children.
Printed Name*
Signature*

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Date*

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NEW SONG MISSION, INC.

COVID-19 NOTICE, RELEASE, AND WAIVER OF LIABILITY

As parents of a child or children (hereinafter referred to as the “Child”) enrolled at or participation in New Song Mission’s program and/or its overnight Adventure Camp or other day camp program (hereinafter referred to as the “Program”), I/We realize that my child’s participation in the Program may result in the exposure to certain risks including exposure to coronavirus (COVID-19), other biological agents, communicable diseases, viruses or similar bacteriological agents (hereinafter referred to as the “Risks”) that may result in the serious bodily injury or death of my child and those with whom my child may later come into contact with and expose to any of the aforementioned medical conditions.

I hereby state that I, on behalf of my child and myself, that I am an adult, over the age of 18, and legally competent to sign this form on behalf of my child. I understand the inherent Risks and dangers my Child may incur as a result of his or her enrollment and/or participation in the Program and acknowledge the existence of risks which are not obvious or predictable, and hereby intend this release to extend to injury or loss which results from the Risks, both foreseeable and unforeseeable.

In consideration of my child participating in the Program provided by New Song Mission, I/we, and any legal representatives, heirs and assigns, hereby release, waive, and discharge New Song Mission, its officers, directors, employees, agents, and representatives from any and all liability for any and all loss or damage, and any claim or damages resulting from any injury, illness or exposure to and/or contracting of the coronavirus (COVID-19) or other biological agents, communicable diseases, virus or similar bacteriological agents by my child, myself, and my immediate family as a result of my Child’s participation in the Program, including any medical expenses, injury and/or death.

I agree to indemnify New Song Mission, its officers, directors, employees, agents, and representatives from any loss, liability, damage, or cost, either direct or indirect, that may be incurred due to my Child’s participation in the Program, whether caused by negligence of New Song Mission or otherwise. I fully understand, on my own behalf and on behalf of my Child the risks associated with the aforementioned participation and assume any risk associated therewith.

This notice, release and indemnity agreement contains the entire Notice, Release, and Waiver of Liability agreement between and among the parties hereto, and the terms of this release are contractual and not a mere recital.

The parties to this agreement hereby agree that the interpretation and enforceability of this document shall be governed by the laws of the State of Indiana.

I expressly agree that this is a release, waiver, and indemnity agreement and it is intended to be as broad and inclusive as permitted by applicable laws, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I understand that by signing this agreement I am giving up on behalf of my Child, myself, and my immediate family members certain legal rights and remedies including the right for my Child and/or myself to recover damages in the event of death, personal and/or bodily injury of any kind, property loss or damage, expenses of any nature whatsoever including attorney's fees, and other losses that my Child or I or those in my immediate family may sustain in association with my Child’s participation in the Program.

I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW AND UNDERSTAND THE CONTENTS THEREOF. I SIGN THIS RELEASE VOLUNTARILY AS MY OWN FREE ACT WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE, INTENDING TO BE LEGALLY BOUND THEREBY.
Signature*

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Printed Name*
Date*

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CAMPER PACKING LIST AND DRESS CODE

WHAT TO BRING:

Medications in original bottles. All medicines prescription or over the counter must be checked in by a parent to a camp leader.

Three days worth of clothing (Clothing should be modest: No bikinis, tank tops, half shirts, short shorts. Please wear shorts that are mid thigh to best participate in all the activities. T-shirts are best!)

One-piece bathing suit

Towel

Water bottle

Personal bathroom items (No razors)

Bug spray

Sunscreen

Small flashlight

Gym shoes (these are important for camp activities)

WHAT NOT TO BRING

Medicines unless turned in by parent to leader

Razors

Money

Cameras

Valuables

Phones or other electronic devices

Clothing with unwholesome words or pictures

Clothing that is not modest, such as bikinis, strap-sleeve shirts, and shorts/skirts/dresses that are above mid-thigh

Tobacco products, alcohol or other substances

Knives (including pocket knives) or weapons
I acknowledge the dress code and packing list*
Signature*

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Should be Empty: