Individual Registration

Please enter information in the form below to process registration for event Young Adult Retreat.

First Name *

Last Name *

Age *

Sex *

Birthdate (month,day, year) *

Please enter in Month, Day, Year (ex: September 10, 2010)

Address *

Address 2

City *

Postal Code *

Country *

Province *

Phone *

Alternative Phone *

Parents/Guardian's Name *

Email *

Cabin Mate

Person Picking Up Camper *

Code Word *

Choose a word that will identify you should a phone call be made during the week.

Medical Insurance Number *

Medical Insurance Province *

Health Concerns

Medication Currently Taking

Are all your immunizations are up to date *

Yes

Date of last Immunization/tetanus *

Emergency Contact *

Emergency contact phone number *

Campers Doctor *

Campers Doctor Phone *

Optional contribution for ongoing expenses

Optional contribution to help with needed renovations to cabins and chapel

PARENT/GUARDIAN PERMISSION FORM

In case of emergency *

In case of emergency, I understand every effort will be made to contact me. In the event that I cannot be reached in an emergency situation, I hereby give permission to licensed emergency and health care personnel to provide treatment, services and transport necessary to maintain the health of my child. In the event medication, medical advice, treatment and/or equipment are required, I agree to accept financial responsibility for fees in excess of provincial and or private medical insurance. I agree that the information on this form may be disclosed to such emergency and health care personnel. In the event of illness, accident, emergency, or any other circumstance requiring medical treatment, such treatment may be procured for the participant without legal or financial obligation to Luseland Bible Camp and One Hope Canada. All known health issues of my child have been stated to the camp. I will notify the camp if my child is exposed to any infectious diseases prior to arriving at camp.

I agree to allow photographs

I agree to allow photographs or video of camp activities, which may include my child, to be used in any and all camp promotional material including the sharing of photographs and videos with ministry partners of One Hope Canada.

Understood the terms of this agreement *

I have read and understood the terms of this agreement and BY ALLOWING MY CHILD(REN) to participate in the camp, I am voluntarily agreeing to abide to these terms. I confirm that the participant [my child] is physically and mentally able to participate in all activities of the camp, unless specifically indicated otherwise in writing.

Right to request *

Luseland Bible Camp reserves the right to request any participant to withdraw from their camp if the participant is not acting in an appropriate and responsible manner.

Right to cancel *

Luseland Bible Camp reserves the right to cancel any week of camp and give a 100% refund.

Permission to connect

We count it a privilege that you are sending your son or daughter to spend the week with us at camp this summer. During a week of camp, we look forward to many great friendships being formed! We have an amazing summer missionary team, and they love to stay connected with their campers throughout the year to hear how they are doing and answer any questions they may have about the topics discussed during chapel session and cabin devotionals. As part of our child and youth protection policy (www.insafehands.ca) we are committed to honouring you as a parent/guardian and to asking your permission before any contact occurs between campers and our missionaries (Facebook, Twitter, phone calls, etc.). Our missionaries would be honoured to be able to continue to stay involved in your child or youth’s life after camp. Please initial to indicate whether or not you give permission to our missionaries to stay in contact with your son or daughter. If you wish to discuss this further, please contact the camp director by phone or email (please see camp website for contact information). If you wish to withdraw your permission, please contact the camp office immediately to notify the camp director.

Informed Consent and Assumption of Risk

IN CONSIDERATION *

IN CONSIDERATION of being permitted to participate in any way at Luseland Bible Camp, (hereafter known as ministry point) operated by One Hope Ministries of Canada , I acknowledge, understand, and agree: The COVID-19 virus pandemic remains an on-going threat. I understand that there still is a risk of exposure to the virus while my child attends the camp, in spite of the precautions that have been taken by the ministry point in following directions outlined by local health authorities to try to limit exposure to the COVID-19 virus or to other communicable diseases. I further understand if my child has a preexisting condition, it may make them more vulnerable to the virus. Participation in activities could result in possible personal injury. Despite precautions taken by the ministry point, accidents and injuries may occur. By signing this form, I assume all risks related to the use of any and all spaces used by the ministry point. To release from responsibility, the ministry point, including all missionaries, full-time and part-time, paid or volunteer, and the facilities used from any cause of action, claims, or demands now, and in the future that might arise out of the participant’s participation in activities at the ministry point or from the physical risks associated with the activities. I accept all risks relating to such activities including personal injury such as: cuts, sprains, scrapes, bruises, fractures, broken bones, concussions, death, or any personal property damage/loss, which may occur on the camp premises. I understand these risks and will not hold the ministry point liable for any such injury. Furthermore, I agree to obey all ministry point rules and take full responsibility for my behaviour in addition to any damage I may cause to the facilities utilized by the ministry point.

I have read *

I have read this Informed Consent and Assumption of Risk Agreement, fully understand its terms and the risks I am assuming by signing it, and sign it freely and voluntarily.

Participant Signature (13 years and older)

I, the participant, *

I, the participant, have read this Informed Consent and Assumption of Risk Agreement, fully understand its terms and the risks I am assuming by signing it, and sign it freely and voluntarily.

FOR PARTICIPANTS OF MINORITY AGE

This is to certify that *

This is to certify that, I, as parent/guardian with legal responsibility for this participant, have read this Informed Consent and Assumption of Risk Agreement, fully understand its terms, and that I have given up substantial rights by signing it, and sign it freely and voluntarily.

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