NW NYI Summer Camp 2022: Student Registration and Adult Application

Northwest Nazarene District NYI Summer Camp 2023: Student Registration and Adult Application

We are so excited that you or your camper(s) are attending camp! Please read every question carefully and answer accordingly. DEADLINES AND PRICING: Early Bird is April 19 - May 31: $250 // June 1- July 14: $260 // DEADLINE to register for Camp is July 14 // Payments should be made through your local church and youth leader, or online via Paypal* below. There is more information about Camp and other NYI opportunities on our website that we encourage you to check out! www.nwnyi.com *For those using PayPal, this price schedule includes a 3% processing fee.
Camper's First Name*
Camper's Last name *
Camper's Sex*

MaleFemale
Grade Level Going Into*

07th08th09th - Freshman10th - Sophomore11th - Junior12th - Senior2023 High School GradAdult Volunteer
Which Church Are You Planning to Attend With? *
Legal Guardian's Email Address*
Used for important updates and reminders leading up to Camp
Mailing Address*
Number, street, city, state, zip (e.g 123 Nazarene Way, Lenexa, KS 55555)
Legal Guardian(s) Full Name(s)*
Legal Guardian Phone Number (1)*
Legal Guardian Phone Number (2)
How Will You Be Paying For Camp?*

I am paying through my local Nazarene Church/ youth leader for CampI am paying through PayPal, and I understand that this will add a 3% processing fee to my total.
How did you first find out about teen Summer Camp?*

Local Nazarene Church, Church Youth Worker, Pastor, etc.Friend or Relativewww.nwnyi.com websiteFacebookInstagramI've always known about District Camps
Adult Application
Why do you want to serve at camp this year?*
How are you currently serving in your church?*
In 3-5 sentences, share when/how you became a follower of Jesus and what your spiritual life looks like now.*
What are your strengths/talents/abilities/hobbies/skills that will be useful at camp?*
What area would you like to help with at camp, in addition to leading a cabin?*
For example, Games, Craft Table, Spiritual Formation, etc..
Do you have a completed background check and a Ministry Safe certificate?*

Yes (please upload it below)No (we will be in contact)
Adult Volunteer Background Check & Ministry Safe Certificate.
Adult Volunteers will need proof of a national criminal background check through Ministry Safe on file with the Northwest District Church of the Nazarene. If you have one through your local church or another entity, please upload that here. If neither you or the NW District has a current background check, we will send you a link to perform a background check.
Background Check Upload
Ministry Safe Certificate Upload
Email and phone number of a pastoral reference--a leader who can provide a reference for you serving at camp:*
Will you be attending the Adult Leader Training Zoom call? This is Sunday, July 16th, early afternoon, online.*

YesNo
Health & Wellness Questions

Help us provide the best care for your camper--as well as providing a safe camping experience for everyone--by answering the following questions with the most accurate information on your camper's health.
Participant's Health Agreement
In the spirit of wellbeing and general health, all participants agree to screen themselves for any health concerns or symptoms for the benefit of the individual and the camp as a whole. Campers are responsible for their health. In the event a participant is not able to attend camp due to health concerns, a refund will be provided per the discretion of the Camp Director. In consideration of the Student's and/or my participation in Camp, the undersigned acknowledges and agrees to and declares the following:*

I am aware of the risk of physically attending Camp and that my Student and/or my participation in Camp may cause injury or illness such as, but not limited to, Influenza, MRSA, or COVID-19 that may lead to paralysis or death.My Student and/or I will not participate in Camp if the Student and/or I experiences the following symptoms within 14 days of Camp: fever (greater than 100.4), fatigue, difficulty in breathing, dry cough, or exhibiting any other symptoms of illness or any communicable disease such as vomiting, Lice (live or eggs), etc.
Agreement*

I, the legal guardian or adult participant, agree to the above statement.
Guardian's or Adult Participant's Signature*

Clear
Health Insurance Provider / Company*
Insurance Policy Number*
Insurance Phone Number of Company*
Will you need to be in the separate meal line due to food allergens? Please clarify what your food allergies are & their intensity.*
List any non-food related allergies, any major surgeries, or other medical conditions chaperones should be aware of. If none, say "none."*
List any prescription medications your camper will bring with them. If none, say "none."*
Emergency Contact Person(s) Name & Relationship*
Emergency Contact Phone Number*
Emergency Contact Secondary Phone Number
Emergency Contact Email Address
Releases & Permissions
The undersigned parent/legal guardian of the above stated participant hereby states that my above named child/ward (or for myself as an adult leader) has my permission to participate in the following described program, tour, event, or trip sponsored by the Northwest District Church of the Nazarene, Spokane, Washington: District NYI Summer Camp at Riverview Bible Camp. The undersigned does hereby release, indemnify, and save Northwest District Church of the Nazarene, Spokane, Washington, its agents, employees, elders, ministers, staff and members, of and from any and all liability or responsibility in connection with any loss or damage sustained by the herein named Participant, including, but not limited to accident, bodily injury, death or property damage, as a consequence of or resulting or arising from or in any manner growing out of any act, omission, or negligence of Northwest District Church of the Nazarene, Spokane, Washington, its agents, employees, elders, ministers, staff, and members in connection with the herein designated program, tour, event or trip. The undersigned does further authorize Northwest District Church of the Nazarene, Spokane, Washington, its agents, employees, elders, ministers, staff and members, to provide or cause to be provided any and all medical attention or treatment as may, in the discretion of Northwest District Church of the Nazarene, Spokane, Washington, its agents, employees, elders, ministers, staff and members, be necessary or advisable, to the child/ward herein named, while such child/ward or adult leader is participating in the herein designated event and further indemnifies and holds harmless Northwest District Church of the Nazarene, Spokane, Washington, its agents, employees, elders, ministers, staff and members, of and from any liability resulting from any medical malpractice claim made in connection with the furnishing of such medical attention and/or treatment.*

I agree to these terms and conditions
Guardian's or Adult Participant's Signature*

Clear
In consideration of RIVERVIEW BIBLE CAMP, I for myself, or the minor child named above, forever waive, release and discharge RIVERVIEW BIBLE CAMP (and its parent corporation) from any/all injuries, claims, disputes, liabilities, or actions resulting from RIVERVIEW BIBLE CAMP providing services for me and for my benefit regardless of location for the dates identified above, except for injury or damage arising out of Riverview Bible Camp’s negligence or willful misconduct. I attest and verify that I have full knowledge of the risks and dangers involved; that I assume such risks, and that I will assume and pay my own medical and emergency expenses, in the event of an accident, illness or other incapacity, regardless of whether I have authorized such expenses. Any controversy arising out of, connected to, or relating to any matters herein of the transactions between me and the above named parties or on behalf of the minor child named below, of this Release/Waiver, or the breach thereof, including, but not limited to any claims of violations of Federal and/or State Law, as well as any common law claims shall be settled by arbitration through Christian Conciliation Services; and in accordance with this paragraph a judgment based upon the arbitrator's award may be entered in any court having jurisdiction thereof in accordance with the provisions of R.C.W. 7.04. This agreement shall be construed and interpreted under the laws of the State of Washington. I HAVE READ THIS WAIVER AND RELEASE CAREFULLY, AND UNDERSTAND IT.*

I agree to these terms and conditions
Guardian's or Adult Participant's Signature *

Clear
My Products
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OPTIONAL Electronic Camp Participant Fee for 1 Camper$257.50
We encourage payment through your local church and youth leader, that will in turn issue a check to the NW District NYI. However, if you wish to pay individually online, the fee includes camp registration plus a 3% electronic convenience fee. Early Bird pricing is April 19 - May 31st = $250* June 1-July 14 = $260* * Plus 3% processing fee for online payment.

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Northwest Nazarene District NYI Summer Camp 2023: Student Registration and Adult Application

Adult Application