RLCC 2018 Registration
RLCC 2018 Registration Form (To be completed NO LATER than July 15th, 2018)

The all-inclusive cost for RLCC 2018 is $110.00. Please mail checks to Newport Ave. Church of Christ, 554 N.W. Newport Ave., Bend, OR. 97701 Cost for a second attendee is $100.00 (subtract $10.00 for each additional attendee). Please be aware that it is the philosophy of RLCC that no child be unable to attend due to financial need. Donors have generously provided sponsorships for those in need of financial assistance. Simply select the option for financial assistance needed at the end of this form to let us know and/or tell us how much you are able to pay.
***PLEASE READ EACH SECTION CAREFULLY***

Name *
(First and Last)
Your answer
Sex *
Age *
Your answer
Grade Completed *
(As of June 2018)
T-Shirt Size *
(Adult Sizes)
Parent/Guardian Name(s) *
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
Emergency Contact *
(Please provide name AND phone number)
Your answer
Medical Information *
Please provide information on any medical conditions as well as medications and dosage
Your answer
Insurance *
Please provide your insurance company, policy number, & name of policy holder for use in the unlikely event of an emergency
Your answer
Payment (please note the address below as it will not be shown after completing registration) *
Checks: payable to Round Lake Christian Camp. Send checks to 554 NW Newport Ave. Bend, OR 97701
Financial Aid
Sponsorships (financial aid) are provided by generous donors to the RLCC fund. By requesting financial aid, you are automatically guaranteed full coverage of cost. If you have selected PARTIAL SPONSORSHIP - please provide your expected contribution to the total cost below:
Your answer
Liability Waiver ***YOU MUST ACCEPT THE TERMS AND CONDITIONS IN ORDER TO COMPLETE REGISTRATION*** *
In consideration of the risk of injury while participating in Camp (the Activity), and as consideration for the right to participate in the Activity, I, hereby, for myself, my heirs, executors, administrators, assigns or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Round Lake Christian Camp/Newport Ave. Church of Christ, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity. I am voluntarily participating in the aforementioned Activity and I am aware of the risks associated with traveling to and from as well as participating in this Activity, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to travel, or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known and unknown to me, of my participation in this Activity, including travel to, from and during this Activity. I agree to indemnify and hold harmless Round lake Christian Camp/Newport Ave. Church of Christ against any and all claims, suits or actions of any kind for liability damages, compensation or otherwise, brought by me or anyone on my behalf, including attorney’s fee and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If Round Lake Christian Camp/Newport Ave. Church of Christ incurs any of these types of expenses, I agree to reimburse Round Lake Christian Camp/Newport Ave. Church of Christ. I acknowledge that this Activity may involve a test of a person’s physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include but are not limited to, those caused by terrain, facilities, temperature, weather, ;lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including by not limited to, participants, volunteers, spectators, coaches, event officials and event monitors, and/or producers, of the event and lack of hydration. In the event of any damage to equipment or facilities occurs as a result of my or my families willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness. This Agreement was entered into at arm’s-length,without duress or coercion, and is to be interpreted as an agreement between two parties or equal bargaining strength. Both the participant , and Round Lake Christian Camp/Newport Ave. Church of Christ agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms to this Agreement, but that it will be interpreted based on the language in accordance with the purposed for which it is entered into. In the event that any provision within this Release of Liability shall be deemed to be sever-able or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not effect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said previsions it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.I, the undersigned participant affirm that I am of the age of 18 year or older, and that I am freely signing this agreement, I certify that I have read this agreement and that I fully understand it’s content. I am aware that this is a release of liability and a contract and that I am signing out of my own free will.In the event that the participant is under the age of consent (18 years of age(, then this release must be signed by a parent or guardian, as follows: I hereby certify that I am the parent or guardian of ,named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.
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