Name
Address

Note

ALL STAFF MEMBERS MUST BE WILLING TO SUBMIT TO A BACKGROUND CHECK, THANK YOU FOR YOUR COOPERATION. WE LOOK FORWARD TO LABORING TOGETHER FOR THE CAUSE OF CHRIST WITH THE YOUTH ATTENDING GRACE BIBLE CAMP.

Have you ever been charged with child neglect or abuse?
Have you ever been convicted of any crimes against children?
1. Have you ever been convicted of or plead guilty to a felony?
3. Are you currently on probation or parole?
2. do you currently have any criminal action pending?
Other than the previous; is there any fact or circumstances involving you or your background that would call into question you being entrusted with the supervision, guidance, and care of young people?
I have read Camp Staff Orientation Information page.

Note

A picture of Staff Member will be taken at camp for Identification purposes and will be placed in staff files.

(Camp Insurance is secondary after primary insurance coverage).
Have you had a physical exam in the past 24 months?
Is your immunization and tetanus up to date?
Do any allergies require an injection?
Permission & Agreement
IN CASE of EMERGENCY: By signing this form I give my permission for the camp health supervisor to administer necessary medications and medical treatment for Camper [or Staff Member] while he / or she is attending Grace Bible Camp. I attest that all information on this form is correct.
Permission & Agreement
I grant permission to Grace Bible Camp and Our Nawakwa, Inc., its agents, and its employees the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family while at Grace Bible Camp held at Camp Nawakwa or in connection with any activities for Grace Bible Camp and Our Nawakwa, Inc. for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium by Grace Bible Camp and Our Nawakwa, Inc. I hereby release Grace Bible Camp and Our Nawakwa, Inc. and its legal representatives from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or evaluation with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.
Hold Harmless and Indemnity Agreement
In consideration of participating in campground activities, and for other good and valuable consideration, I hereby agree to release and discharge my liability arising from negligence OUR NAWAKWA, INC. and it’s owners, directors, officers, employees, agents, volunteers, and all other persons or entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs, assigns, personal representatives, and estate and also agree as follows: 1. I acknowledge that participating in campground activities involves knows and unanticipated risks which could result in physical and emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, broken bones, torn ligaments or other injuries as a result of falls; burns from campfires; drowning in pools or other bodies of water; falls from play equipment or caused by uneven surfaces; medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity. 2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation. 3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury and damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume and bear the costs of – all risks that may be created, directly or indirectly, by any such condition. 5. In the event that I file a lawsuit, I agree to do so solely in the state where Releasee’s facility is located, and I further agree that the substantive law of that state shall apply. 6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence. I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. I have read and understood this document and I agree to be bound by its terms.

Registration / Health Form and all monies must be received by Camp Registrar 7 days prior to Camp Week for camper to attend camp.

Sign and date to verify all information is correct and that you understand permissions and agreements and hold harmless and indemnity agreement.