Ramona Youth Summer Camp

Student Information

Name

Phone

Address

Parent/Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

Parent/Guardian Email

This address will receive a confirmation email

Church Affiliation

What church do you or the person who invited you attend?

Calvary Chapel Ramona Grace Community Church Mountain View Community Church Hillside Community Other

Release of Liability and Medical Information

Please read and sign below...

I hereby consent to & authorize my child (above) to participate in “Ramona Summer camp” conducted by Grace Community Church, Mountian View Community Church and Calvary Chapel Ramona on July 12-16, 2021. We further authorize my child (above) to travel with representatives of the Churches in private or churches vehicles. If a parent, family physician, or dentist cannot be contacted promptly, and a medical or dental emergency has been determined to exist, the undersigned parent or guardian of the child named above hereby authorizes any representatives of the Church for and on behalf of the undersigned, to consent to any x-ray, anesthetic, medical, surgical or dental diagnosis of treatment and any hospital care deemed advisable and rendered by any licensed physician, or surgeon, EMT, nurse, or dentist, whether in his/her office or in any licensed hospital or health care facility. This authorization is given in advance of any such required care for purposes of empowering any such representative or official of the Church to give the above described consent for any such medical, or dental, as he/she may deem advisable. We herby agree to pay any and all reasonable charges incurred as a result of any such medical or dental treatment and to hold the Church and its representatives and officials harmless. The undersigned hereby release the Church and its authorized representatives and officials of and from any and all liability to the undersigned arising out of or in connection with activities related to the Church, or any travel connected therewith, except for such liability as may arise from the gross negligence or willful misconduct on the part of the Church or its representatives or officials. To the extent that any applicable law prevents or prohibits the under signers’ release of the Church from any liability to child(above) as set forth herein, we hereby agree to indemnify and hold harmless the Church and its representatives and officials of and from any such liability as may be imposed upon any of them.

I have read and agree to the terms above

If my students becomes a discipline problem, I understand that I may be required to pick them up or arrange for their immediate transportation home at my expense. This will be determined by the youth leaders, and all monies for the trip are non-refundable.

I have read and agree to the terms above

Electronic Signature

Medical Insurance provider

Medical Insurance policy number

My student may be given ibuprofen for headaches/pain at the leaders discretion/discernment

Yes No

Are there any medications or food allergies that we need to be aware of

Yes No

If you answered yes please explain here

Additional activities

During our time at camp students will have the opportunity to participate in addtional activites at a cost. If your student is interested in participating in Arrow tag ($10) please check the appropriate box below.

Please check one of the boxes below for activities

Optional T-shirt Purchase

If you would like to buy a camp T-shirt for an additional $15 please fill out the info below. Last day to purchase a shirt is on June 13.

T-Shirt Size

Tshirt payment options

Camp Payment options (choose from the drop down menu)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Ramona Youth Summer Camp

Description

Please Fix the Following