Camper/Counselor Registration, Health & Waiver, Transportation & Emergency Medical Forms

MINNETONKA CHRISTIAN CAMP REGISTRATION
THIS FORM IS REQUIRED FOR EVERY PERSON IN YOUR GROUP

*NO PETS ALLOWED*
Camper Name
Camper Phone
Gender

MaleFemale
Camper Age
Camper Birthday

MonthDayYear
Date
Parent/Guardian Name
Parent/Guardian Phone
Address
Attending Church
HEALTH
Camper Shot Records (These are required for any medical treatment that may be required)

PLEASE PROVIDE A COPY OF YOUR CHILD'S UPDATED SHOT RECORDS TO VBC YOUTH DIRECTORS BEFORE CAMP. THANK YOU!
LAST DATE ADMINISTERED

Please list the dates each of the following shots were last administered:
Measels

MonthDayYear
Date
Mumps

MonthDayYear
Date
Rubella

MonthDayYear
Date
Meningococcal

MonthDayYear
Date
Hepatitis A

MonthDayYear
Date
Hepatitis B

MonthDayYear
Date
Tetanus

MonthDayYear
Date
Diphtheria

MonthDayYear
Date
Please list all allergies or restrictions:
Any Medical or Special Treatment?
Authorization for Medical Treatment

By signature I agree that this information is accurate and true. By signature I give permission for diagnoses, therapeutic, and operative procedures as deemed necessary.
Guest Signature

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Parent/Guardian Signature (If guest is under 18)

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Please print first and last name as signed above:
WAIVER
Campers who have not had their 13th birthday, and anyone who cannot pass a basic swim test are required to wear a U.S. Coast Guard approved flotation devices while participating in swimming or boating activities. Also, additional activities that may be offered at camp include basketball, canoe, challenge course, hiking, volleyball, horseshoes, kayak, paddle boat, paintball, softball, swimming, waterslide, zipline, etc.

As Parent/Guardian I give my permission for my child to participate in all activities at Minnetonka Christian Camp, and waive any liability on the part of Minnetonka Christian Camp.
Consent for Camper participation in activities, and for the use of images or recordings of camper without compensation:
Guest Signature

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Parent/Guardian Signature (If guest is under 18)

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Please Print first and last name as signed above:
COVID-19 WAIVER

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

Minnetonka Christian Camp has put in place numerous preventative measures and enhanced cleaning protocols to reduce the likelihood of spreading COVID-19 at Minnetonka Christian Camp. However, Minnetonka Christian Camp cannot guarantee that you or your child will not become infected with COVID-19. Further, attending a Minnetonka Christian Camp summer camp could increase your child's risk of contracting COVID-19.

By signing the agreement, I assume the risk that my child, myself, and other family members may be exposed to or infected by COVID-19 by attending any camps and activities at Minnetonka Christian Camp, and that such exposure or infection may result in personal injury, illness, permanent disability or death.
I understand that the risk of becoming exposed to or infected by COVID-19 at Minnetonka Christian Camp may result from actions, omissions, or negligence of myself, my child and others, including, but not limited to, Minnetonka Christian Camp employees, volunteers, other campers and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injuries to 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 Minnetonka Christian Camp summer camps and programs.

On my behalf, and on behalf of my child, I hereby release, covenant not to sue, discharge, and hold harmless Minnetonka Christian Camp, 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

I understand and agree that this release includes any Claims based on the actions, omissions or negligence of Minnetonka Christian Camp, its employees, volunteers, agents, and representatives, whether a COVID- 19 infection occurs before, during or after participation in a Minnetonka Christian Camp summer camp program.

Symptoms of COVID-19 may include:
- Fever or Chills
- Cough
- Shortness of breath or difficulty breathing
- Fatique
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore Throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
By clicking each box I agree to the following:

I understand the above symptoms and affirm that I and my household members have not experienced any of the symptoms above within the last 14 days.I affirm that I and those in my household have not been diagnosed with COVID-19 within the past 30 days.I have not knowingly been eposed to anyone diagnosed with COVID-19 within the past 30 days.I affirm that I have not traveled outside of the country withing the past 30 days.
Guest Signature

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ParentGuardian Signature If guest is under 18

Clear
Relationship to Guest (If guest is under 18)
Please Print First and Last Name As Signed Above:
EMERGENCY MEDICAL AND TRANSPORTATION PERMISSION FORM
Event
Date

MonthDayYear
Date
Name
Age
Grade
Gender

MaleFemale
Address (House Number & Street Name)
City
State
ZIP CODE
Email
example@example.com
In the event of an emergency, I hereby give permission to Victory Baptist Church to arrange for any necessary medical, surgical, or hospital care for my child, ___________ ,(please insert child's name in box given below) due to illness, injury, or other incidents occurring while they are under the care or direction of the church. I understand that I am responsible for all medical expenses incurred and release Victory Baptist Church from any legal or financial liability related to such care.

I also authorize any licensed physician or medical personnel secured by the church to provide treatment as deemed necessary under the circumstances.

Furthermore, I give permission for my child to be transported by Victory Baptist Church for events and activities as needed.
Child's Name
In case of emergency please contact:
Contact
Phone
Does your child suffer from allergies, asthma, or any other illness we would need to be aware of?

YESNO
If YES, please explain:
If your child is taking any medication, list the medication below and give the directions for taking it:
If there are any additional instructions or needed information you would like us to know about your child please explain below:
Signature of Parent or Guardian

Clear
Camper's T-Shirt Size
Should be Empty:

MINNETONKA CHRISTIAN CAMP REGISTRATION

HEALTH

LAST DATE ADMINISTERED

WAIVER

In case of emergency please contact: