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Section 1 of 8
2019 Lakeview Women's Retreat Registration
Thank you for your interest in Lakeview Christian Camp's 2019 Women's Retreat!

If you have any questions while filling out the form, you may call 785-639-3063 or email the registrar: registrar@lakeviewchristiancamp.org.

There is no need to print any of this information out to bring with you to the retreat. We are using a 100% electronic registration process.
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Section 2 of 8
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Section 3 of 8
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Thank you for your interest in Lakeview Christian Camp's 2019 Women's Retreat!

If you have any questions while filling out the form, you may call 785-639-3063 or email the registrar: registrar@lakeviewchristiancamp.org.

There is no need to print any of this information out to bring with you to the retreat. We are using a 100% electronic registration process.
Section 4 of 8
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Section 5 of 8
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Option 1
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Do you want to fill out and sign the release to participate in the climbing wall and/or zip line?
Question Type
This MAY be an active option. If you would like to participate, you must have the release section filled out. If you're not sure, then go ahead and fill it out and you can decide at the retreat.
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Section 6 of 8
Climbing Wall / Zip Line Release
Only campers entering 4th grade and older need to have this section of the release filled out in order to participate in the climbing wall and/or zip line. If you have reached this page in error, hit your browser's back button and answer the question, "Is the camper entering grade 4 or over?" or "Do you want to grant the camper permission to participate in the climbing wall and/or zip line?" NO
1. Is the participant younger than 18 years of age?
Question Type
If yes, a parent or guardian must fill out this release form. Parent, please read and go over each section with the minor participant.
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No
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2. Does the participant require an inhaler for asthma attacks?
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If YES, it is your responsibility to make sure that your prescribed inhaler is readily available during the program.
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No
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3. Is the participant allergic to bee stings or other insect bites?
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If YES, it is your responsibility to make sure that your prescribed medication or shot(s) are readily available during the program.
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No
Unknown
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4. Is the participant diabetic?
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If YES, it is your responsibility to make sure that you have food or prescribed medication readily available during the program.
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No
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5. Does the participant have a history of seizures?
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No
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5a. If YES (the participant does have a history of seizures), do you want an ambulance called if you experience a seizure while participating in this program?
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No
N/A - No history of seizures
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6. Does the participant have a history of high blood pressure or heart problems?
Question Type
If YES, you are at risk if you participate physically in this program. There is historical evidence that some individuals with pre-existing heart conditions have suffered heart attacks and death after participating in a Challenge course/Climbing program. Due to the emotional and physical demands inherent to the activities, you may be jeopardizing your health and well-being if you choose to fully participate. You should consult your physician prior to attending the program.
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Yes - you should consult your physician prior to participating in the program.
No
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7. Is the participant pregnant?
Question Type
If YES, you and your unborn child are at risk if you participate physically in this program. Unintentional impacts to your abdomen can occur during many of the activities that involve physical contact. If climbing is a part of your program, you will be required to wear a harness that puts pressure on your abdominal area and back. Due to the types of physical demands inherent to the activities, you may be jeopardizing your health and well-being, as well as the health and well-being of your unborn child, if you choose to fully participate. You should consult your physician prior to attending the program.
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Yes - you should consult your physician prior to participating in the program.
No
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8. Is the participant recovering from broken bones, dislocated joints, sprains, strains, back, or neck injuries?
Question Type
If YES, you are risking re-injury if you participate physically in this program. You should consult your physician prior to attending.
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Yes - you should consult your physician prior to participating in the program.
No
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9. Do you have an enlarged organ, are a transplant recipient, or have Downs Syndrome?
Question Type
If YES, you are risking injury to weakened areas of your body. You should consult your physician prior to attending the program.
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Yes - you should consult your physician prior to participating in the program.
No
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10. Do you have any concerns that might limit your participation in physical activity?
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Participating in this program may involve bending, twisting, lifting, running, jumping, climbing, increased heart or breath rates, and/or physical contact with others. Unexpected strains or jolts to your body can occur.
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Yes (please explain below)
No
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10a. List any concerns you have (if any)
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11. Do you anticipate needing physical assistance from us during your participation?
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No
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11a. What assistance will you need? (if any)
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12. Do you acknowledge that you have read and understand the following statement?
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Lakeview Christian Camp recommends that you do not physically participate in activities that you think might put you at risk. If you are concerned, your Facilitator can provide you with a less physical way to stay involved.
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Yes
No - YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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13. Select I Agree after reading and agreeing to the following statement:
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I understand that Challenge Course/Climbing activities are, by their nature, physically and emotionally demanding, and that participating in the Lakeview Christian Camp program may involve bending, twisting, lifting, running, jumping, climbing, swinging, increased heart or breath rates, and/or physical contact with others.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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14. Select I Agree after reading and agreeing to the following statement:
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I understand that although the Lakeview Christian Camp staff will make every reasonable effort to minimize exposure to known risks, not all dangers and hazards can be foreseen (i.e. cuts, bruises, scrapes, fractures, fatalities, etc.).  I am aware that certain risks and dangers exist in the activities that are beyond the control of Lakeview Christian Camp and its employees and volunteers.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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15. Select I Agree after reading and agreeing to the following statement:
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I understand that I have the right and the responsibility to limit my participation in any activity that I believe will compromise my safety, and agree to notify a Lakeview Christian Camp employee or volunteer if I have safety concerns.  If I choose to physically participate in any of the activities, I voluntarily assume all risks associated with such participation.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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16. Select I Agree after reading and agreeing to the following statement:
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I understand that the Lakeview Christian Camp staff has the right to deny my participation and that it is my responsibility as a Participant to follow the safety guidelines and procedures established by the Facilitator(s). If, at any time, I do not understand or have not heard specific instructions given by the Facilitator(s), I realize that it is my responsibility to ask for clarification and/or assistance.
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I Agree
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17. Select I Agree after reading and agreeing to the following statement:
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I state that I am not now under the influence of any chemical substance including alcohol, and that I will not be under the influence of any substance when participating in the Lakeview Christian Camp program.  I realize that participating in these physical activities while under the influence of any substance would endanger others and myself.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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18. Select I Agree after reading and agreeing to the following statement:
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I am aware that I might be photographed and/or videotaped during my participation, and authorize such photographs and/or videotapes to be used by Lakeview Christian Camp and/or sponsoring churches in training or promotional materials now or at any point in the future. I understand that my name will NOT be used and/or published (unless further consent is obtained), and that I will NOT receive compensation for the use of such photographs and/or videos.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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19. Select I Agree after reading and agreeing to the following statement:
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I give my consent to Lakeview Christian Camp employees, volunteers and to emergency medical personnel to treat me if they deem it to be medically necessary. I authorize the Lakeview Christian Camp staff and volunteers to secure such medical advice and services as they feel necessary for my health or well-being. I give permission for emergency anesthesia and/or surgery that might be necessary due to an illness or injury occurring during my participation.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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20. Select I Agree after reading and agreeing to the following statement:
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I agree to accept financial responsibility for any medical expenses and/or loss of income not covered by my insurance policy that occurs as a result of my participation in the Lakeview Christian Camp program.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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21. Select I Agree after reading and agreeing to the following statement:
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I understand and assume all dangers and risks associated with my participation in the Lakeview Christian Camp program and waive, release, and discharge Lakeview Christian Camp and their agents, officers, and employees from all claims or causes of action arising from my participation. I do hereby release Lakeview Christian Camp, and their agents, officers, and employees from any and all liability, and agree to indemnify and hold Lakeview Christian Camp harmless for any accidents, injury, loss, and/or damage of property, and from any legal fees that I may ever have as a direct or indirect result of participating in the Lakeview Christian Camp program. This release, indemnification, and waiver shall be construed broadly to the maximum extent under applicable law.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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22. Select I Agree after reading and agreeing to the following statement:
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My signature on this document is also intended to bind my representatives, administrators, successors, heirs, next of kin,  and assigns on by behalf.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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23. Select I Agree after reading and agreeing to the following statement:
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By signing below I am agreeing that I have carefully read and agree to all of the sections agreed to above. I am also verifying that the information listed on the Health History Section is complete and accurate to the best of my knowledge.
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I Agree
I do NOT agree. YOU WILL NOT BE PERMITTED TO PARTICIPATE IN THE CLIMBING WALL OR ZIP LINE IF YOU SELECT THIS ANSWER.
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Medical Insurance Policy Number
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Section 7 of 8
Release Forms
All participants must agree to the following in order to attend Lakeview Christian Camp.

I hereby give permission to Lakeview Christian Camp to use any photographs, accounts, or videos of myself or child taken by staff or volunteers to be used for related camp activities, programs, and/or promotion, including printed material and on internet and social media sites, by Lakeview Christian Camp and/or its sponsoring churches.

I understand that completion of the medical form with my electronic signature grants me participation in Lakeview programs. Without a Climbing Wall/Zip Line Release Form I will not be allowed to participate in the climbing wall/zip line activities.

I release Lakeview Christian Camp staff, faculty, volunteers, officers, and sponsoring churches from all liability. I agree to indemnify, defend, and hold harmless Lakeview Christian Camp, staff, faculty, volunteers, officers, and sponsoring churches for any injuries or damages incurred while participating in the camp program and/or on camp property.

Payment & Registration Policy:

By submitting this registration you are agreeing to pay for the spot for which you are registering. There will be no refunds given for cancellations made after April 15, 2019. Cancellations made prior to April 15 will be subject to a $10 administration fee.

If for some reason you cannot attend, another person can take your place with no penalty, but no refunds will be given after April 15, 2019. You are responsible for payment whether or not you have actually paid by April 15.

Once you fill this registration form out, you are agreeing to pay for your spot regardless of when we actually receive your payment or when your invoice is mailed out.

Payments should be mailed directly to the camp. An invoice will be emailed to the email address you provided in this registration. All invoices must be paid in full upon receipt unless payment arrangements have been made.

Early Bird Registration:

All registrations received by midnight on April 15, 2019 will receive $10 off the camp price.

I agree with all of the previous statements.
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This is a required answer. Agreement is required for registration and participation.
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Section 8 of 8
Medical Appointment of Agent
This form is required by the local hospital.
3951
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I hereby appoint Lakeview Christian Camp and its representatives, of lawful age, as my agent and representative for the purpose of authorizing and consenting to hospital care and/or medical care and treatment for myself for any illness or injury that may occur while I am with the agent between the dates of January 1, 2019, and December 31, 2019, if I am not immediately available to give such consent.
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Jill Emery
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Do you want to fill out and sign the release to participate in the climbing wall and/or zip line?
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Climbing Wall / Zip Line Release
1. Is the participant younger than 18 years of age?
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2. Does the participant require an inhaler for asthma attacks?
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3. Is the participant allergic to bee stings or other insect bites?
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4. Is the participant diabetic?
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5. Does the participant have a history of seizures?
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5a. If YES (the participant does have a history of seizures), do you want an ambulance called if you experience a seizure while participating in this program?
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6. Does the participant have a history of high blood pressure or heart problems?
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7. Is the participant pregnant?
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8. Is the participant recovering from broken bones, dislocated joints, sprains, strains, back, or neck injuries?
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9. Do you have an enlarged organ, are a transplant recipient, or have Downs Syndrome?
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10. Do you have any concerns that might limit your participation in physical activity?
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10a. List any concerns you have (if any)
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11. Do you anticipate needing physical assistance from us during your participation?
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11a. What assistance will you need? (if any)
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12. Do you acknowledge that you have read and understand the following statement?
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13. Select I Agree after reading and agreeing to the following statement:
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14. Select I Agree after reading and agreeing to the following statement:
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Medical Insurance Policy Number
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Release Forms
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Medical Appointment of Agent
3951
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I hereby appoint Lakeview Christian Camp and its representatives, of lawful age, as my agent and representative for the purpose of authorizing and consenting to hospital care and/or medical care and treatment for myself for any illness or injury that may occur while I am with the agent between the dates of January 1, 2019, and December 31, 2019, if I am not immediately available to give such consent.
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