Camp Evangel (Summer Camp Form)
"Christ in Everything"
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact/ Guardian(s)
Phone Number (Home or Cell)
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (Home or Cell- Option 2)
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (Home or Cell- Option 3)
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
Female
Male
Age
Roommate Request
-Select the Camp Week you will be attending. Junior ages 8-12, Teen ages 13-18
Teen Week 2- July 21-25
Juniro Week 2- July 28-Aug. 1
Medical: Camper's Insurance Co. & Policy #
Name of Policy Holder
Date of Last Tetanus Shot
Medical Information: Medications, Allergies, Dietary Restrictions, or Other Pre-existing conditions
Please list any allergies, and actions taken. Note the medications taken and when given (A.M./ P.M.)
Covid Waiver Assumption of the Risk and Waiver of LiabilityRelating to Coronavirus/COVID19Camp Evangel has put in place numerous preventative measures and enhanced cleaning protocols to reduce the likelihood of spreading COVID-19 at Camp Evangel. However, Camp Evangel cannot guarantee that you or your child will not become infected with COVID-19. Further, attending a Camp Evangel summer camp session could increase your child’s risk of contracting COVID-19. By signing the agreement, I acknowledge the contagious nature of COVID-19. I assume the risk that my child, myself and other family members may be exposed to or infected by COVID-19 by attending any camp and activities at Camp Evangel, and that such exposure or infection may result in personal injury, illness, permanent disability, or death.I understand the risk of becoming exposed to or infected by COVID-19 at Camp Evangel may result from actions, omissions, or negligence of myself, my child, and others, including, but not limited to, Camp Evangel employees, volunteers, other campers, and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injuries my child, myself, and other family members (including, but not limited to, personal injury, disability, or death), illnesses, damages, losses, claims liability, costs or expenses, of any kind (collectively, “Claims”), that I, my child and our family may experience or incur in connection with my child’s attendance at Camp Evangel summer camps and programs.On my behalf, and on behalf of my child, I hereby release, covenant not to sue, discharge, and hold harmless Camp Evangel, its employees, volunteers, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on actions, omissions or negligence of Camp Evangel, its employees, volunteers, agents, and representatives, whether a COVID-19 infection occurs before, during or after participation in a Camp Evangel summer camp program.
Yes, I agree.
No, I do not agree.
Please sign the application below....In signing this application, I hereby certify that the person named on this form is in good health and may participate in the activities of Camp Evangel. (Exceptions are listed on attached sheet.) In case of medical emergency, I authorize Camp Evangel officials to secure medical treatment that includes injection, anesthesia, surgery, or dental treatment for the camper named on this form. I agree the camper will abide by Camp Evangel rules of conduct and use of camp property; and will participate fully in the camp program. If Camp Evangel officials deem it necessary for him/her to return home because of illness or any other reason, I will abide by the Camp’s decision and make arrangements to bring him/her home. I give permission to use photos including the camper for publicity. I/we understand the possibility of unforeseen accidents and incidents; agree not to hold Camp Evangel/SBI, its leaders, staff, and volunteers liable for damages, losses, disease, or injuries incurred by the subject.
May we administer Tylenol, Ibuprofen, and Benadryl if necessary?
Yes
No
Names of people who may pick up your camper.
List name(s) in the text box.
Did you come with a church group this week?
Yes
No
If you did come with a church group this week, what is the name of your church?
Church
If you are part of the Bible Release Time, what school do you attend?
Name of School (Only applies to students that participate in the Bible Release Time.)
Submit
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