Staff Registration Form

Name*

First NameLast Name

Gender*

MaleFemale

Birthdate

MonthDayYear

Email

example@example.com

Cell Phone*

Home Phone

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Congregation

Camp Position

T-Shirt Size (Adult)*

Dietary Needs

Insurance Information

Medical Questions

Check if you have you been hospitalized or treated by a physician within the last year? If yes, why?Check if you have you had a tetanus shot within the past five years?Check if you have any known allergies?Check if you have any physical or medical condition that we should be aware of?Check if you are currently taking medication?

Reason for Hospitalization

List Food Allergies

List Medication Allergies

List Environmental Allergies (Pollen, Etc.)

Physical or Medical Condition We Should Be Aware Of

What Medications?

Medication Frequency?

List Medications Being Brought to Camp?

Any Other Medical Concerns

Participation in any program which involves physical activity exposes the staff to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect the camper from all conceivable dangers.

I hereby authorize all treatments and procedures as ordered or deemed necessary by Cascade Friends’ Camp Medics, Tall Timber Medics, local hospital physicians, nurses, or assistants, or local emergency medical services to be performed upon the above-registered camper in any case of his or her illness, injury or health emergency.

I hereby affirm that I has/have no conditions that would make it unsafe for me to participate in the camps program(s) selected. I understand and acknowledge that I am responsible for reviewing Cascade Friends Camp health and safety protocols for Summer Camp and ensuring that I and my child(ren) follow those protocols.

By signing this Waiver and Release of Liability, with full appreciation of the risk involved, on my own behalf and on behalf of my child(ren), I hereby voluntarily release and forever discharge Cascade Friends Camp, its trustees, directors, officers, volunteers, agents, insurers and contractors from any and all legal or financial responsibility for any personal injury, disability, illness, damage, medical expense or death, arising from or related to my child(ren)’s participation in Summer Camp. I agree, for myself and my child(ren), not to make any type of legal or equitable claim against Cascade Friends Camp, or any of its trustees, Directors, officers, volunteers, agents, insurers or contractors with respect to any injury I or my child(ren) may suffer, whether or not it arises through the negligence, omission, default or other action of anyone affiliated with the camp, including other campers. I further agree that if any such claim is made, I will indemnify and defend Cascade Friends Camp with respect to any such claim, injury or damage

Signature

Contact*

First NameLast Name

Email

example@example.com

Cell Phone*

Home Phone

Registration Amount

Fees for food and lodging

Canteen Amount

Candy and snacks

Donation Amount

Helps kids draw closer to God by experiencing camp

Total Amount

RegistrationType

Staff Registration

Medical Release

Emergency Contact

Payment