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Camp Idrafoje 2019 Registration
Please fill out this form and pay a $50 nonrefundable deposit (link provided on next page) to hold your spot for Camp Idrafoje this summer. Camp runs from Tuesday, June 25 through Saturday, June 29. The total cost of camp is $195.
Camper's Name *
Your answer
Month and day of Camper's Birthday (Example: April 10)
Your answer
Camper's Upcoming Grade In School (2019-2020) *
Gender *
Parent/Guardian Name *
Your answer
Relationship to Camper *
Your answer
Street Address *
Your answer
City, State, and Zip *
Your answer
Cell Phone Number *
Your answer
Parent/Guardian Email (Confirmation and all other correspondence will be done through email. Please note that Yahoo often directs our emails to the junk folder. Add campidrafoje@gmail.com to your contacts to avoid this.) *
Your answer
Does Your Camper Have Any Allergies?
Your answer
Does your camper have any medical issues we should be aware of?
Your answer
Choose a t-shirt size for your camper. *
We try our best to accommodate camper requests to be in the same teepee as a friend or two. Campers are grouped by gender, of course, and by grade level. Within those guidelines, we can usually guarantee your camper will be with at least ONE other person you requested. Does your camper have a request to be placed with any other campers?
Your answer
PARENT/GUARDIAN WAIVER: I understand a child who does not abide by the rules of the Church of the Open Door Activities may be dismissed from any and all events. Signature Parent/Guardian on this form waives and releases Church of the Open Door and its workers from liability due to injury or illness incurred at C.O.D. or traveling to and from the church. Participants are responsible for their own property. Church of the Open Door and its workers will not be responsible for lost or stolen items. *
PHOTO RELEASE: I give the Church of the Open Door and its employees and agents the right to photograph my child and use the photo and/or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing including via the internet. *
AUTHORIZATION TO CONSENT TO TREATMENT OF MINOR: (I) (We), the undersigned, parent(s) of the aforementioned Camp Idrafoje attendant, a minor, do hereby authorize Church of the Open Door and its leaders as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act whether such diagnosis or treatment is rendered at the office of said physician or at a hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until the parent(s) have indicated otherwise in writing to said agent(s). I, the parent/guardian, shall indemnify, hold free and harmless, assume liability for, and defend Church of the Open Door, its agents, servants, employees, officers, and directors from any and all costs and expenses including but not limited to, attorneys’ fees, reasonable investigative and discovery costs, court costs, and all other sums which Church of the Open Door, its agents, servants, employees, officers, and directors may pay or become obligated to pay on account of any, all and every demand for, claim or assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of the aforementioned Idrafoje attendee, use of real personal property belonging to Church of the Open Door, its agents, servants, employees, officers and directors, or by any action or omission by the aforementioned Idrafoje attendee. *
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