Seeing All Receive Isaiah 61, inc.

Email*

example@example.com

Primary Adult / Guardian Name*

First NameMiddle or NicknameLast NameSuffix

Birth Date*

MonthDayYear

Primary Adult / Guardian Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Second Adult / Guardian Name

First NameMiddle or NicknameLast NameSuffix

Birth Date

MonthDayYear

Second Adult / Guardian Phone Number

Please enter a valid phone number.

Are you bringing any children to the retreat?*

YESNO

Child Name

First NameMiddle or NicknameLast NameSuffix

Birth Date

MonthDayYear

Youth Cell Number

Please enter a valid phone number.

Do you have multiple children? (if answered "YES" please list them below; if oyu have more than 3 children you must fill out a second form)*

YESNO

Child Name

First NameMiddle or NicknameLast NameSuffix

Birth Date

MonthDayYear

Child Cell Number (if applicable)

Please enter a valid phone number.

Child Name

First NameMiddle or NicknameLast NameSuffix

Birth Date

MonthDayYear

Child Cell Number (if applicable)

Please enter a valid phone number.

Do any adults listed above have any Health Conditions? (i.e. Diabetes, Asthma, Epilepsy, Seizures)*

YesNo

If answered "yes" please list conditions below.

Are there any daily or life saving medications associated with the above conditions that need to be known?*

YesNo

If answered "yes" please list conditions below.

Do any children listed above have any Health Conditions? (i.e. Diabetes, Asthma, Epilepsy, Seizures)*

YesNo

If answered "yes" please list conditions below.

Are there any daily or life saving medications associated with the above conditions that need to be known?*

YesNo

If answered "yes" please list conditions below.

If any children are currently taking medication that must be administered daily or anytime during the course of the trip, a parent/guardian must be present to administer this medication. SARI 61 will not provide any medication to anyone for any reason. So, please plan accordingly.

You can also find a full list of supplies and/or materials that we suggest on our website.

Primary*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Secondary

First NameLast Name

Phone Number

Please enter a valid phone number.

While at SARI 61 Ministries Camping Grounds….

1) I will be honest and respectful (of my peers, the camp staff, and myself).
2) I will follow directions and rules at camp.
3) I will not act violently toward any camper or staff member.
4) I will not steal or destroy property belonging to SARI 61 Min. Retreat., other campers, or staff members.
5) I will stay out of areas marked with orange tape and I understand that I will be responsible for replacing the items in those areas, should I or my child break them.
6) I will not use/practice inappropriate conduct and language (such as profanity, vulgarity, or sexual behavior).
7) I will abide by the dress code listed below.
a. No Clothing with profanity, nudity, drug relation, occult relation, political views, or any other explicit, violent, or political propaganda material is allowed.
b. No crop top, halter top, or skirts.
c. Shorts must be no higher than 6 in. Above the knee and all chest and stomach areas must be covered at all times.
d. Men/ Boys must keep their shirts on at all times and we WILL NOT tolerate any walking around in boxers, briefs or any other undergarments that are not normally shown in public.
8) I will not bring any Illegal Drugs, Alcohol or any other illegal substances with me or in my vehicle.
9) I will not bring any firearms with me or in my vehicle.
10) I will keep any medication prescribed to my or my children in a safe spot away from other campers and out of reach of other children.
11) I will stay within camp boundaries unless I am traveling with a staff member.
12) I will do my best to HAVE FUN!!!

Please Click box: I AGREE*

DISCIPLINE WILL BE HANDLED IN THE FOLLOWING MANNER:

Step 1: Counselors will address behavior with the camper, helping the camper to understand the rules and take responsibility for changing their behavior.

Step 2: The Director and/or Senior staff will meet with the camper to discuss and implement solutions.

Step 3: The camper will be removed from camp. A parent or guardian will be asked to pick up the camper from The Retreat Land Camp as soon as possible. Adult Camper or Parent/ Guardian is responsible for pickup/transportation from The retreat Land. (Unless otherwise determined by The Church or Youth Director of the group)

SOCIAL MEDIA

We have Social Media platforms where photos and videos from Group events are periodically published. It is our policy that photos of children are never published with names or other identifying information without parental consent.

Yes, you can use pictures and videos of my child. I hereby give SARI 61 permission to use my child’s likeness in photographs, video, and other media in all of its publications, including bulletin boards and website entries. I waive any right to royalties or other compensation arising or related to the use of photographs or videos.

Please Click box: I AGREE*

GENERAL RELEASE:

“I/We hereby release from any liability S.A.R.I. 61 Ministries and all of its personnel, employees, adult leaders and representatives from any claims for unintended or unexpected accidents which might occur during participation in group events or traveling to or from said events. In granting this permission and release, I/We specifically recognize that I may from time to time be transported to events by private vehicles operated by advisors or volunteers not as agents, employees or representatives. In such regard, I/We specifically release and will hold harmless Seeing All Receive Isaiah 61 inc. , their officers, employees, agents and representatives from any and all liability which may arise as a result of such transportation whether or not organized by S.A.R.I. 61 Ministries.”

"I also grant permission for Leadership to use emergency Medical Operations by local Hospital, Ambulance, or any other certified Medical caregiver; in the event that it my be needed."

“I/We hereby grant permission for my child/ children to attend Camp and to participate in activities arranged by the Leadership. We recognize the importance of the commitment that they make and that their participation as a part of a larger community calls for responsible behavior. Therefore, I/we agree that if this child engages in behavior which, in the judgment of the adult leaders, is not in the best interest of the trip or event, our/my child or any member of the group may, therefore, be sent home. I/We will assume full legal and financial responsibilities for such a return trip.”

"I/We specifically recognize that my child may from time to time be transported to events by private vehicles operated by advisors or volunteers not as agents, employees or representatives."

I   First Name*   Last Name*   , agree to adhere and make my child (if any listed above) adhere to all rules and regulations of Seeing All Receive Isaiah 61 ministries.

Signature*   Date*

Seeing All Receive Isaiah 61, inc.

REGISTRATION AND RELEASE FORM

Medical Questionnaire

Emergency Contact