Clone of Open Registration Middle School 1 Registration

I understand that:
● Activity programs involve the use of equipment and physical skills of the participant, and that participating in these and related activities may result in injury.
● Participants in our high ropes course may be more than twenty feet above the ground, belayed and/or suspended above the ground, falling, climbing, running, jumping, and moving about the course.
● The possibility exists that a participant in our high ropes course could fall and hit the ground, another participant, or another object.
● Accidents can occur hiking. Trails are often steep, rocky, and slippery.
● A participant may be exposed to natural elements which can be uncomfortable or harmful, possibly resulting in sunburn,
dehydration, heat exhaustion, heat stroke, heat cramps, hypothermia, or frost bite.
● Participation in camp activities will increase heart rate.
● Many natural hazards exist in a rural setting. Insect, reptile, and/or animal bites may be experienced while participating
in the programs of CrossView Christian Camp & Retreat Center.
●CrossView Christian Camp includes paintball as part of its activities program, and certain risks exists on the paintball field and with the use of paintball guns.

I understand that CrossView Christian Camp is not responsible for any personal injury, property damage, or loss of personal effects resulting from a Natural Disaster, (e.g., Flood, Fire, Tornado) or related events. I understand the list of potential risks is not exclusive or exhaustive. I understand that no activity program is absolutely safe and free from risk. I agree to assume full responsibility for myself and that of my family, including minor children. I expressly assume all risk and responsibility involving accidents sustained while participating in activities at CrossView Christian Camp & Retreat Center resulting from negligence on my part, that of my family, or employees, officers, directors, or agents of CrossView Christian Camp & Retreat Center. I affirm that I am fully capable of participating in this activity and that my general health is good. I do not have any condition that might endanger the life or health of myself or others participating in this activity. I understand the signature of the parent or guardian of a minor child on this document shall make all provisions of this release and assumption of the risk agreement applicable to and binding on the minor child.

I give my permission to the employees, agents, sponsors, or directors of CrossView Christian Camp & Retreat Center to act on my behalf in the event I or my child require medical attention while participating in the events and activities of
CrossView Christian Camp & Retreat Center.

Authorization for Medical Treatment

I understand that in case of medical emergencies involving my Child, I shall be notified right away. In case any of my provided contact information is unreachable, I authorize the organization to call the doctor indicated above. In case the doctor is not available, I authorize the organizers to call any doctor to provide the necessary medical attention to my child.

I understand that the camp shall not be responsible, and shall be reimbursed, for any medical expenses incurred by them over this authorization.

Signed (Parent/Guardian of Minor Camper) :

Camper's Name

First NameLast Name

Parent/Guardian Name

First NameLast Name

Parent/ Guardian of Minor Camper signature

Relationship to Camper (minor)

Today's Date

Date

Photography Release

Signed (Parent/Guardian of Minor Camper) :

Today's Date

Date

2026 Summer Camp Registration Form

Camper's Legal Name

First NameLast Name

Camper's Nickname

Gender

Birth Date

MonthDayYear

Age

Grade going into next fall

Camp Group & Dates

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

T-shirt Size

What is this child's race?

Camper's Height

Camper's Weight

Date of Last Tetanus

Date

Please list chronic conditions (long lasting health conditions that require ongoing care)

Has your Camper undergone surgery?

If you Camper has had surgery in the past or is going to have surgery in the future, please tell us more about the surgery so we can take the best possible care of your Camper:

Please make a list of all medications and dosages that your child is taking. Then please let us know the reason for each medication.

Please list ALL current medications and dosages

Bedwetter?

Bladder/ Bowel Problems?

If yes, please explain:

Please list all allergies (drug/ food/ bee stings/grass etc)

Health Insurance Company

Policy #

This child has all the vaccinations required to attend a Texas Public School.

Hospital Preference

Physician Name:

First NameLast Name

Physician Phone #:

Please enter a valid phone number.Format: (000) 000-0000.

Please list any Learning Disabilities your child may have. If none, mark "N/A"

(Please list any Behavioral Difficulties your Camper may have (i.e. Impulsivity, Lying, Tantrums, Defiance, Aggression, Antisocial, Changes in eating patterns). If none, mark "N/A"

Please list any diagnosis your Camper may have (i.e. PTSD, Bipolar, FAS, Autism, ADD, ADHD, OCD, ODD, CD). If none, mark "N/A."

Has this child been retained in a grade at least once?

Is this participant on probation?

If yes, for what crime and what are the terms of probation?

If yes, what is the level of his/her care:

Was/ is this child in residential treatment?

Type a question

If yes, yes when did the child enter residential treatment?

If yes, why is this child in residential treatment?

Other helpful information we should know about this child (i.e. personality, interests, hobbies, etc.)

Parent/Guardian Information

Parent/ Guardian Name

First NameLast Name

Parent/Guardian Cell Number

Format: (000) 000-0000.

Parent/Guardian E-mail **This is the email the we will use to communicate with you.

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

An opportunity for water baptism will be presented during your child’s week of Camp. Every person baptized at CrossView receives a signed “baptism letter” with a color picture of their baptism. In the event your child expresses an interest, do you give your consent for him/her to be baptized?

CrossView Camp raises over $250,000 annually in scholarships for Summer Camp. Collecting the following information about our Campers and their families helps us obtain this funding. We will determine whether your child qualifies for a
scholarship to CrossView’s Summer Camp 2026 based on family size and income. Failure to provide accurate answers to the following questions will automatically disqualify your child for a scholarship. Angel Tree Families will always automatically qualify for CrossView's scholarship. The following information will be kept confidential.

Is this child in foster care?

Has this child ever been in foster care?

Is this child a "sibling" of foster child(ren)?

Number of people living in this child's household:

Total MONTHLY household income

Total YEARLY household income:

What is this child's family situation:

Are any adults in this household unemployed?

Are either of this child's parents currently incarcerated (even if a non-custodial parent)?

If this child has a biological parent or a step parent that is currently incarcerated, please tell us the name of the incarcerated parent:

First NameLast Name

If this child has a biological parent or a step parent that is currently incarcerated, please tell us the name of the facility that they are in or the last known facility:

Has this child ever been enrolled in an Alternative Education Program (such as Project Intercept)?

If this child has ever been enrolled in a detention facility or an Alternative Education Program, please tell us why:

Parent/Guardian Signature - Emergency Action Plan

I certify that the above information is true and correct to the best of my knowledge.

Today's Date

Date

CrossView Christian Camp and Retreat Center

Sign Releases

Medical Information

Learning & Behavior Information

Scholarship Information

Crossview's Emergency Action Plan