Pinecrest Summer 2025

Camp Johnsonburg, where Pinecrest is held, is an entirely NUT FREE FACILITY.

Johnsonburg Staff ensure that the camp kitchen and dining hall are free of all nuts, nut-based products, and products that may include nuts.

Therefore, out of respect for our hosts, and for the safety of fellow campers, any snacks brought by campers to also be entirely nut free.

Please note: Every effort will be made to satisfy requests for dietary needs or medically supervised diets. However, please recognize that we are employing the services and facilities of a camper center where certain limitations may apply. Your cooperation is essential. Special dietary requests can be honored only if notification is received prior to camp session enabling us to make necessary arrangements. Thank you.

Does the participant:

OTC Permission

By initialing here, I give permission for my child to be given (as needed) the following Over The Counter Meds: Motrin, Tylenol, Benadryl, medications for diarrhea, constipation, and cough drops.

Notice: Limited Camper accident insurance is provided which requires each camper to have a completed/signed medical form on file. Without it, medical coverage cannot be provided.

Permission for Treatment

To the best of my knowledge the above information is correct. I hereby give my permission to the physician and/or nurse practitioner to treat, hospitalize and perform any procedure necessary, including but not limited to injections, x–rays, anesthesia or surgery in case of emergency.

It is my understand, if this medical is for a minor, all efforts will be made to contact a parent/guardian prior to any treatments, or immediately following stabilization of an emergency. Consent Form mist be SIGNED by parent/guardian if applicable to a minor or by a camp participant if age 18 or older.

Permission for Photography

If so, please upload a copy of your health insurance card below. We encourage campers over 18 to have a copy of their insurance card with them (ie: a photo of it on their phone).

Pinecrest may require copies of your camper's health insurance card for use in the event of an emergency.

I understand that my/my child’s participation in activities led by Pinecrest Lutheran Leadership Ministries, Inc. “Pinecrest” staff is completely voluntary, including transportation to/from Camp Johnsonburg. I have familiarized myself with the camp activities in which I/my child will be participating.

I recognize that certain hazards are inherent to camp events and programs, particularly, but no limited to, the activities of sports, service projects, canoe/kayak, and group building initiatives. I understand that the other activities, particularly, but not limited to, ropes courses, climbing wall, zip line are not part of our program but are on site and off limits to participants.

I acknowledge that although Pinecrest has taken safety measures and establishes practices to minimize the risk of injury to participants, Pinecrest cannot ensure no guarantee that the participants, equipment, premise, and/or activities will be free of hazards, accidents or injury. Pinecrest is not responsible for my/my child's property. I further recognize the importance of knowing and abiding by camp rules, regulations, and procedures for the safety of all participants.

The undersigned understands and desires to participate or gives permission for my child to participate in the activities noted above.

The undersigned does herby assume full risk and agree to hold harmless, release, remit, acquit and forever discharge Pinecrest Lutheran Leadership Ministries, Inc., its staff, faculty, volunteers, facility, agents, successors and assigns, of and from all claims, demands, cause of action, obligations, rights, damages, losses, expenses, costs, joinders or controversies arising out of my/my child’s participation in any program or activity at Pinecrest, Johnsonburg or off-site with Pinecrest staff.

Participant Agreement: In consideration for the named person on this account (“Participant”) being allowed to participate in activities organized by Pinecrest Lutheran Leadership Ministries at the Presbyterian Camps known as Johnsonburg Camp and Retreat Center. (the “Camp”), I hereby acknowledge and agree to this release of liability, waiver of legal rights, and assumption of risk under the following terms: I acknowledge that participating in activities or presence at the Camp, including, without limitation, the attendance at or participation in any event held at the Camp facility (whether presented, hosted or sponsored by the Camp or a third party), involves participation in or observance of physical recreational activities that involve inherent dangers that no amount of care, caution, instruction or expertise can eliminate. The activities that the participant may participate in include, but are not limited to, challenge course activities, high ropes course activities and other high adventure activities including, but not limited to, boating/paddling, backpacking, rock climbing, mountain biking, and hiking. These activities can be a strenuous and require the Participant to be in good physical condition. I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.
I certify that the participant does not suffer from any physical infirmities or illnesses which would affect the participant’s ability to engage in these activities. I understand that during some of these activities, participant may be exposed to psychologically and physically challenging situations. I acknowledge that although the program has taken precautions to provide proper organization, supervision, instruction and equipment for each activity it is impossible for the program to guarantee absolute safety. Also, I understand that the participant and I share responsibility for safety of the participant, and I assume that responsibility. I accept responsibility for verifying the health of the participant and certify that the participant has no physical or psychological problems that would prohibit the participant’s participation in this program.
I hereby release, waive, discharge, and covenant not to sue the Camp and any its affiliates, members, owners, managers, directors, officers, employees, trustees, agents, subsidiaries, affiliates, administrators, staff, directors, and all other persons involved with such entities (collectively, “Releasees”) from any and all demands, claims, suits, losses or damages of any nature and kind on account of property damages or personal injury (including without limitation death or paralysis) caused or alleged to have been caused, in whole or part, by the negligence or willful acts of the Releasees (collectively, “Damages”). I hereby agree that if any provision of this Waiver and Release Form is held invalid or is prohibited, the balance of the document shall (notwithstanding such invalidity or prohibited provision) continue in full force and effect. All disputes, claims, questions, or differences arising from, relating to or in connection with this Waiver and Release or the participant’s participation in any activity at or presence at a Camp facility, including, without limitation, the enforceability or applicability of all or any portion of this Waiver and Release, shall be finally settled by arbitration administered by the American Arbitration Association in accordance with the provisions of its then current Consumer Arbitration Rules by a single arbitrator. The place of arbitration shall be in New Jersey. The arbitration shall be governed by laws of the State of New Jersey. I understand that the decision of the arbitrator shall be final, binding and conclusive upon me and the Camp. The arbitrator shall not have the power to award any consequential or punitive damages. I agree to hold the existence, content and result of the arbitration in confidence, except to the limited extent necessary to enforce a final settlement agreement or to obtain or enforce a judgment on an arbitration decision and award. I ACKNOWLEDGE AND AGREE THAT THE INCLUSION OF THIS ARBITRATION CLAUSE SHALL IN NO WAY IMPAIR THE VALIDITY OR ENFORCEABILITY OF ANY WAIVER OR RELEASE OF LIABILITY SET FORTH HEREIN.