Camp78 2018

Wed 20 - Sat 23 Jun 2018

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Booking details

Registration type

Prices are in USD.

Who’s this registration for?

e.g. dietary (gluten intolerant, vegetarian, etc) or other requirements

Camper Information

Parent/Guardian Information

Emergency Contact

In case of an emergency, parents will be contacted first. If unable to reach parents, emergency contacts will be called in order listed.

Insurance

Parental Consent/Medical Release

DEAR PARENT, PLEASE MAKE SURE YOUR CHILD UNDERSTANDS THE IMPORTANCE OF SAFETY ON TRIPS LIKE THIS!!! WE OFTEN TIMES WILL BE LIVING “ON THE TRAIL.” ENCOURAGE THEM TO THINK HOW THEIR ACTIONS COULD EFFECT THEMSELVES AND EVERYOE ELSE ON THE TRIP!!!!

I, THE UNDERSIGNED PARENT OR GUARDIAN OF ABOVE MINOR, DO HEREBY AUTHORIZE ANY ADULT WORKER WITH “RUSH” YOUTH MINISTRY AT “THE RIVER,” TO CONSENT TO ANY EXAMINATION, X-RAY, ANESTHETIC, MEDICAL OR SURGICAL OR TREATMENT AND HOSPITAL CARE WHICH IS RENDERED UNDER SUPERVISION OF ANY MEDICAL PRACTICE ACT ON THE MEDICAL STAFFF OF A LICENSED HOSPITAL, WHETHER SUCH DIAGNOSIS OR TREATMENT IS RENDERED AT THE OFFICE OF SAID PHYSICIAN OR AT SAID HOSPITAL. FURTHER, I GIVE PERMISSION FOR “RUSH” WORKERS TO GIVE MINOR TREATMENT SUCH AS BANDAIDS AND PAIN RELIEVERS. FURTHER, AS PARENT OR GUARDIAN OF THE MINOR NAMED ABOVE, I DO HEREBY EXPRESSLY CONSENT THAT MY SON/DAUGHTER MAY RECEIVE EMERGENCY MEDICAL TREATMENT FROM ANY PHYSICIAN, HOSPITAL, OR OTHER MEDICAL CENTER WITHOUT THE NECESSITY OF FIRST NOTIFYING ME, AND DO FURTHER AGREE TO HOLD BLAMELESS ANY PHYSICIAN, HOSPITAL, OR OTHER MEDICAL CENTER FOR RENDERING SUCH SERVICES.