Camper Registration Form 2023

Ascension Summer Camp 2025 Camper Registration Form
PLEASE READ THE ENTIRE APPLICATION AND FOLLOW DIRECTIONS CAREFULLY!

**REGISTER NOW as spots are limited! Please submit your application as soon as possible.Please note that a spot at camp for your child/children cannot be guaranteed until all forms and payment is received.
Application Checklist ** Please make sure the following items are complete and ready to be included with your registration submission**

Complete the Camper Registration Form online below and click submit, you will receive a pop up after completion that states your application has been submitted.Upload a copy of the campers CURRENT Medical Insurance card (front and back)When your registration is complete and accepted, you will be emailed a payment invoice. We accept VENMO and VANCO (the church payment system for credit cards). INVOICE EMAILS WILL BE SENT AFTER APRIL 1st.
Click Next to begin camper registration

CAMPER INFORMATION

Please submit one application per camper
Child's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*
Birthdate*

MonthDayYear
Date
Child's Age as of June 7, 2025 **
Child's Grade in School*
Current Grade that child is completing now
Shirt Size*
Parent or Guardian's Name*

First NameLast Name
Parent's email*
example@example.com
Parent's Cell Phone*
Please enter a valid phone number.
Additional emergency contact, other than parent listed above.*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.

Camp Registration Fees

Please note that there is pledged and non-pledged pricing. If registering for more than one camper, please select the appropriate option below.
Parent or Guardian's Ascension Cathedral Pledge Number
Camper Registration Fees*
prevnext( X )
1 Camper (pledged)
$745.00



1 Camper (non-pledged)
$895.00



2 Campers (pledged)
$1,400.00



2 Campers (non-pledged)
$1,700.00



3 Campers (pledged)
$2,100.00



3 Campers (non-pledged)
$2,550.00



Total

$0.00
Payments

When your registration is complete and accepted, you will be emailed a payment invoice. We accept VENMO and VANCO (the church payment system for credit cards). INVOICE EMAILS WILL BE SENT AFTER April 1st. If you have any questions about the registration fee or payment, please contact George Landis or Peter Anastopoulos.

CAMP WAIVERS

By digitally signing these waivers within this application, parents/guardians acknowledge that their signature is legally binding and fully compliant with applicable laws. The digital signature holds the same legal validity as a handwritten signature, ensuring the authenticity and integrity of the consent provided.

PARENT/LEGAL GUARDIAN AUTHORIZATION FOR HEALTH CARE & FINANCIAL RESPONSIBILITY
I, blanks* [Parent/Legal Guardian], as the parent/legal guardian ofblank* [Camper’s Full Name], authorize Ascension Summer Camp and
its staff to obtain medical care for my child in the event of illness, injury, or medical emergency while attending Ascension Summer Camp. I understand that reasonable efforts will be made to contact me or the emergency contact listed below before initiating medical treatment, unless immediate care is required.

I further authorize any licensed physician, medical facility, or healthcare provider to provide any necessary treatment, including but not limited to x-rays and other diagnostic exams, routine tests, anesthesia, surgery, medication, hospitalization, and any related medical procedures deemed necessary by medical professionals.

I understand and agree that I am responsible for all costs incurred for any such medical treatment, including but not limited to emergency transportation, hospitalization, and any related medical expenses. I agree to reimburse Ascension Summer Camp for any expenses it may incur in obtaining medical treatment for my child.

This authorization shall remain in effect for the duration of my child’s participation in Ascension Summer Camp activities, June 7, 2025 through June 15, 2025.
PARENT/LEGAL GUARDIAN
Name:*

First NameLast Name
Phone Number*
Please enter a valid phone number.
EMERGENCY CONTACT
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
HEALTH INSURANCE INFORMATION
Insurance provider*
Policy Number*
Parent/Legal Guardian Signature*

Clear
Date

MonthDayYear
Date

RELEASE, DISCHARGE, WAIVER OF LIABILITY AND COVENANT NOT TO SUE AGREEMENT
Name of Participant:*

First NameLast Name
Name of Parent/Legal Guardian if Participant is under the age of 18:

First NameLast Name
I, or if a minor, my parent/legal guardian (hereinafter collectively referred to as “PARTICIPANT”), FULLY ACCEPT AND ASSUME ALL RISKS IN attending Ascension Summer Camp, including traveling to/fromAscension Summer Camp and all activities while at Ascension Summer Camp (hereinafter referred to as“ACTIVITY”), WHETHER KNOWN OR INHERENT IN THE ACTIVITY OR NOT, AND RESPONSIBILITY FOR ANYAND ALL PERSONAL INJURY, DEATH, PROPERTY DAMAGE, LOSSES, COSTS, ATTORNEYS’ FEES AND DAMAGES PARTICIPANT may incur as a result of such participation in ACTIVITY. TO THE FULLEST EXTENT ALLOWED BY LAW, PARTICIPANT HEREBY RELEASES, DISCHARGES, WAIVES ANY CLAIM OF LIABILITY AGAINST, AND COVENANTS NOT TO SUE the Ascension Summer Camp, AscensionGreek Orthodox Cathedral, Greek Orthodox Archdiocese of San Francisco, Greek Orthodox Archdiocese of America, all affiliates of each of the foregoing, and their respective directors, staff, officers, employees, parish council members, volunteers, and agents (hereinafter referred to as “RELEASEES,”)FROM ANY AND ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES CAUSED, OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE RELEASEES OR OTHERS, AND PARTICIPANT FURTHER AGREES that if, despite this RELEASE, DISCHARGE, WAIVER OF LIABILITY AND COVENANT NOTTO SUE AGREEMENT (hereinafter referred to as “AGREEMENT”) PARTICIPANT, or anyone onPARTICIPANT’s behalf, makes a claim against any of the RELEASEES, PARTICIPANT WILL INDEMNIFY,SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any and all litigation expenses, attorneys’ fees, loss, liability, damages, or costs which may be incurred as the result of such claim. Without limiting the generality of the foregoing, PARTICIPANT acknowledges and assumes the inherent risk of exposure to COVID-19 that exists by visiting any place where other people are present, andPARTICIPANT further HEREBY RELEASES, DISCHARGES, WAIVES ANY CLAIM OF LIABILITY AGAINST, AND COVENANTS NOT TO SUE ANY OF THE RELEASEES FOR ANY ALLEGATION OR CLAIM relating to any person becoming infected with, becoming ill/disabled from, or dying from COVID-19. Further, PARTICIPANT agrees to INDEMNIFY, SAVE AND HOLD HARMLESS RELEASEES from any and all civil liability, fines, penalties, costs, attorneys’ fees, legal fees, or expenses incurred by or imposed onRELEASEES arising from or related to PARTICIPANT’s conduct, including but not limited to any personal injury, death, or damage to persons or property caused directly or indirectly, in whole or in part, by any willful or negligent act or omission on the part of PARTICIPANT. This AGREEMENT shall be binding upon and shall inure to the benefit of PARTICIPANT and to PARTICIPANT’s legal successors, heirs, administrators and assigns. PARTICIPANT has read this AGREEMENT in its entirety and freely and voluntarily assumes all risks of injuries and damages and notwithstanding such risks, PARTICIPANT agrees to participate in ACTIVITY.
I HAVE READ THIS AGREEMENT THOROUGHLY AND AM SIGNING IT VOLUNTARILY ON BEHALF OF MYSELF AND, IF APPLICABLE, THE MINOR LISTED ABOVE, AND OUR RESPECTIVE HEIRS, NEXT OF KIN,ASSIGNS, PERSONAL REPRESENTATIVES AND RELATED INDIVIDUALS. NO ONE HAS MADE ANY REPRESENTATIONS, STATEMENTS OR INDUCEMENTS THAT CHANGE OR MODIFY ANYTHING WRITTEN INTHIS AGREEMENT. **IF YOU ARE A MINOR (UNDER AGE 18), YOUR PARENT OR LEGAL GUARDIAN MUST SIGN THIS AGREEMENT ON YOUR BEHALF.
Participant*

Clear
PARTICIPANT’S PARENT/LEGAL GUARDIAN (if PARTICIPANT is under the age of 18)

Clear
Date

MonthDayYear
Date

Camp Policies and Conditions of Enrollment

1. The camper, his/her parents and relatives agree to abide by the rules and regulations set by Camp for the health, safety and welfare of all the campers. 2. Campers are expected to use appropriate language, are not allowed to smoke or chew tobacco, or possess any smoking materials such as vapes and e-cigarettes, and may not use or possess alcoholic beverages or illegal drugs. 3. All medications, drugs, aspirin, cough syrup, etc. must be kept in the Nurse’s Cabin under the control of the Camp Health Supervisor. 4. Cell phones, iPods, MP3 players, video games, tablets, or other electronic devices are not permitted at Camp. 5. Campers are encouraged to develop friendships with members of the opposite sex; however, exclusive relationships or sexual behavior is strictly prohibited at Camp. 6. All personal belongings are to remain unlocked at camp. The Camp Directors reserve the right to look through any camper’s belongings for inappropriate items if deemed necessary. 7. Camp is not responsible for articles of clothing or personal belongings lost or damaged by fire, theft, laundry, etc. 8. Racial and sexual harassment, or any other form of harassment including bullying, is not permitted while at Camp. 9. Violence of any kind including fighting or weapons are not permitted are not tolerated. 10. All rules and policies are strictly enforced. Any criminal act(s) or failure to abide by Camp rules may result in immediate dismissal from camp with no refund. 11. Parent/Guardian acknowledges by signature below that he or she is responsible for communicating this information to camper and any other adult responsible for the child. 12. Parent/Guardian acknowledges by signature below that he or she is responsible toprovide immediate transportation home if the camper is unable to complete the sessiondue to homesickness, illness, inappropriate behavior or violation of any of the CampPolicies.
We have read and mutually understand and agree to abide by the above listed policies.
Parent Guardian Name*

FirstLast
Parent / Guardian Signature*

Clear
Date

MonthDayYear
Date
Camper Name

FirstLast
Camper Signature

Clear
Date

MonthDayYear
Date

Cell Phone Free Policy

To provide a safe, immersive, and enriching camp experience, Ascension Summer Camp is excited to commit to a cell phone-free camp. While we have always been a “no cell phone” camp, in recent years, campers have had a difficult time truly disconnecting. To ensure campers have the most valuable experience possible, they will not be allowed to bring or use cell phones, tablets, or smart watches during their stay and are required to leave them at home.
Goals for this policy are:

1) Promoting Independence: Campers will learn to reflect more on themselves, their peers, and will more deeply reflect on their relationship with God. 2) Ensuring Safety: Removing cell phones reduces the risk of loss, theft, and misuse, creating a safer environment for everyone. 3) Enhancing Focus and Presence:Being free from digital distractions helps campers stay present and fully engaged in camp activities, enhancing their overall experience.
Implementation

Leave Cell Phones at Home: Campers should not bring cell phones to camp, even for the bus ride. Parents are asked to ensure their children comply with this policy. Confiscation: If a cell phone is seen on the bus or at camp, it will be confiscated by staff, securely stored at camp headquarters, and returned to the camper at the end of the session when we return to church. Ascension Summer Camp cannot be held responsible for lost or damaged cell phones.
Parent/Guardian Acknowledgment:

I understand and agree to the No Cell Phone Policy for my child during the Ascension Summer Camp program. I understand that failure to comply with this policy may result in the confiscation of my child’s phone and may impact their participation in camp activities.
Name

FirstLast
Signature

Clear
Date

MonthDayYear
Date
Camper Acknowledgment:

I, understand and agree to follow the No Cell Phone Policy and understand that bringing a cell phone to camp is not permitted.
Name

FirstLast
Signature

Clear
Date

MonthDayYear
Date

What have we forgotten to ASK?
Please provide any additional information that would be helpful to know about your camper.
First time camper? Please let us know how you found out about our camp program
Parent / Guardian Name*

First NameLast Name
Relationship to camper*
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

	Type	Reaction
Allergy
Allerrgy
Allergy
Allergy

Ascension Summer Camp 2025 Camper Registration Form

PLEASE READ THE ENTIRE APPLICATION AND FOLLOW DIRECTIONS CAREFULLY!

Click Next to begin camper registration

CAMPER INFORMATION

MEDICAL INFORMATION

Camp Registration Fees

Payments

CAMP WAIVERS

PARENT/LEGAL GUARDIAN AUTHORIZATION FOR HEALTH CARE & FINANCIAL RESPONSIBILITY

PARENT/LEGAL GUARDIAN

EMERGENCY CONTACT

HEALTH INSURANCE INFORMATION

RELEASE, DISCHARGE, WAIVER OF LIABILITY AND COVENANT NOT TO SUE AGREEMENT

Camp Policies and Conditions of Enrollment

We have read and mutually understand and agree to abide by the above listed policies.

Cell Phone Free Policy

Goals for this policy are:

Implementation

Parent/Guardian Acknowledgment:

Camper Acknowledgment: