Camp Good News Registration Form 2020
Dear Parents and Guardians,
In a time of much confusion and frustration around our country, we are pleased to offer this summer camp for your kiddos. We are working on making the best camp possible and we appreciate you taking the time to fill out this registration form and help us prepare as best as we can. We do ask if your child has knowingly been exposed to Co-Vid19 or if your children are sick at all, please opt for our at home camp option. We will look forward to seeing your child next summer at camp. Also, please make sure you read this registration form completely and carefully.
Which Camp Will your Child Attend? *
Camper Name *
Age *
Address *
City *
State *
Zip Code *
Birthday *
T-Shirt Size *
Parent Name *
Parent Cell: *
Parent Work Number *
Emergency Contact Name: *
Relationship to Camper *
Emergency Contact Primary Phone Number *
Emergency Contact Secondary Phone Number *
Is there anything we should know about your child? (sleeping habits, special needs)
Is there anyone banned from having contact with your child? *
Health Insurance Provider *
Health Insurance Policy Number *
Camper's Physician Name: *
Does your camper have any known allergies? *
Please list any medications your child is currently taking along with any directions our nurse might need.
List any special dietary concerns your child might have. (We at Camp Good News make every effort to provide nutritious meals for each of our campers, if specialty food is required on a large scale for your child, please bring the food with your child for our kitchen to distribute. Typically, we can easily accommodate gluten, milk, egg, and peanut allergies as these are the most common)
Our camp nurse keeps a lot of non-prescription medications available to give as needed. Please check the box of any items you DO NOT want your child to have. *
Medical Release Waiver: Parents will be contacted in case of serious sickness or accident. However, there could be an emergency situation that requires immediate medical attention. In the even that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Camp Good News staff person in charge to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child. I also hereby give Camp Good News permission to administer the medications listed on this registration form. *
Model Release: I consent to my child's image, likeness, voice, or any representation of them to be used in the publication of photographys, video recordings or audio recordings made by Child Evangelism Fellowship and/or Jericho Hills Campground for posters, magazines, books or other publications. I release Child Evangelism Fellowship and Jericho Hills as a publisher of such photographs, video recordings or audio recordings, of all claims to compensation for any such publications. It is understood that Child Evangelism Fellowship retains full and complete ownership of all rights to any such photographs, video recordings or audio recordings. *
COVID-19 Waiver: The novel coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World HealthOrganization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Camp Good News has put in place preventative measures to reduce the spread of COVID-19; however, cannot guarantee that your child will not become infected with COVID-19. Further, attending camp could increase your child's risk of contracting COVID-19.By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child may be exposed to or infected by COVID-19 while attending the Camp Good News and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Camp Good News may result from the actions,omissions, or negligence of myself and others, including, but not limited to, Camp Good News employees,volunteers, and program participants and their families.I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my children (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense,of any kind, that my children may experience or incur in connection with their attendance at Camp Good News. On my child's behalf, I hereby release, covenant not to sue, discharge, and hold harmless Camp Good News, Jericho Hills Camp and Retreat Center, Child Evangelism Fellowship, its employees, 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 thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the the above named company, its employees,agents, and representatives, whether a COVID-19 infection occurs before, during, or after attending camp. *
By checking the 'I agree' boxes above and entering my full name below I recognize that this is equivalent to my legal signature. *
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