2019 Student Life Summer Camp Registration
Registration for RCC's 6th-12th grade summer camp.
Student's Name:
Your answer
Grade:
Gender:
Parent's Name:
Your answer
Parent's Phone number:
Your answer
Parent's Email:
Your answer
Emergency Contact if cannot reach parent:
Your answer
Please list any Allergies or Medications:
Your answer
If any, please list scheduling conflicts:
Your answer
T-shirt size:
What do you hope for your child to get out of summer camp?
Your answer
Any additional notes or comments:
Your answer
THIS RELEASE AND HOLD HARMLESS Agreement is executed on the date below, by and between Ripon Community Church's summer camp programs and GLCC; and the child whose name is printed below. The child, together with his/her parent or legal guardian, is referred to herein as the “Participant.” IN CONSIDERATION of being permitted to enter and use the grounds and other Facilities of Harris Lake, and other good and valuable consideration, the Participant hereby agrees to the following terms: PARTICIPANT hereby releases, waives, and discharges GLCC and Ripon Community Church camp programs, all officers, directors, employees, volunteers, or teaching staff, and each of them (individually or collectively ) from any and all liability to Participant for any and all loss or damage to participant on account of injury to the Participant or the Participant’s personal property, while the Participant is participating in any of the activities sponsored or conducted on the premises. PARTICIPANT further agrees to indemnify GLCC and Ripon Community Church from any loss, liability, damage or cost that they may incur due to any harm suffered by the Participant. Participant agrees to never institute suit or action against GLCC or Ripon Community Church for damages, cost, expenses, or loss of series resulting or arising from any such loss, damage, or injuries. PARTICIPANT agrees to use Principles of “Leave no Trace” on the property, and to repair anything used and broken or lost from the property. PARTICIPANT acknowledges that any and all allergies or medical conditions have been disclosed and discussed with the leader. PARTICiPANT also acknowledges that due to the outdoor nature of this program, the participant may be exposed to poison ivy, and may sustain bug bites, including ticks, stings, bites, scratches, and falls. Activities on site may include ropes course, swimming, fire building, and free roaming on the GLCC grounds. PARTICIPANT acknowledges that he/she are financially responsible for any medical cost related to any injuries sustained while at camp. Because the Participant is a minor, this release and Hold Harmless Agreement shall be executed by a parent or legal guardian, and shall be binding upon both parents or all legal guardians as well as upon the participating minor. Said parent or guardian by the execution here of, waives all claims to their individual or derivative capacity, as well as claims on behalf of the participant. PARTICIPANT expressly agrees that the Release and Hold Harmless Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Wisconsin, and that if any portion here of is held invalid, it is agreed that the balance shall notwithstanding continue in full legal force and effect. *
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