Need Help? Have Questions?

Email: vacationbiblecamp@thenbcf.org

425.282.6220

VACATION BIBLE CAMP 2019

PARTICIPANT REGISTRATION FORM

Crista Camps- Miracle Ranch 15999 Sidney Road SW, Port Orchard, WA 98367

https://cristacamps.com

This camp offers paintball, archery, horses, petting zoo, high & low ropes courses, lake front activities

and much, much more! The Vacation Bible Camp team, the teachers and the counselors are excited

and ready to return for another amazing weekend!

Camp Dates:

Friday, July 19th, 2019 –Parent drop off at NBCF estimate 1:00pm

Sunday, July 21st, 2019- Parent pickup at NBCF estimate 12:30pm

Transportation:

NBCF will provide transportation via First Student to and from the camp location. Times for

check in/pick up will be confirmed shortly.

Price:

Total cost per student is $165.00 -Your cost $70.00- We Got The Rest!

But you have to make the Registration Deadline of May 31st, 2019

You may still register until June 15th, 2019, however it will be full price and only if space is

available.

CHECKLIST FOR APPLICATION

Submit one complete application per student (pages 2-5) Complete all segments of application; simply mark N/A if it does not apply.

Grade refers to grade student was in during the 2018-2019 school year.

Ministry & Church Form- Obtain church school teacher or ministry lead signature.

Submit proof of payment, if available.

Page -1-

2019 VACATION BIBLE CAMP COMPLETE ONE FORM FOR EACH CAMPER

Participant Information Camper Name: _______________________________________ Cell Phone #: (________)____________________

Birth Date: ___/___/___ Age: ____ Gender: ☐F ☐M Current Grade: _____ School:_____________________

Home Address:_________________________________________________________________________________

City, State, Zip: _________________________________________ Home Phone (________)___________________

Emergency Information Parent/Legal Guardian/ Emergency Contact #1:_____________________________________________ __________

Relationship: _________________________________ Best way to contact: ☐Home Phone ☐Cell Phone

Home #: (________)___________________________ Cell # : (________)_____________________________

Parent/Legal Guardian/ Emergency Contact #2: _____________________________________________________

Relationship: _________________________________ Best way to contact: ☐Home Phone ☐Cell Phone

Home #: (________)___________________________ Cell #: (________)_____________________________

Is anyone legally restricted from being in contact with any of your child? ☐YES ☐NO

If YES, who (Full Name): __________________________________________________________________________

Medical Insurance

Medical Insurance Carrier________________________________________________________________________

Policy or Group #__________________________ Patient ID #________________________________

Name of insured person__________________________________________________________________________

Health Information (check all that apply)

☐Hypoglycemic ☐Asthma ☐Bleeding Disorders ☐Heart Defect/Disease ☐Seizures ☐____________

☐Food Allergies __________________________________________________________________

☐Drug Allergies _________________________________________________________________

☐Other Allergies _______________________________________________________________

☐Other conditions that may impact the ability of the child to safely participate in activities:

______________________________________________________________________________________________

Dietary Restrictions (please be specific)

_____________________________________________________________________________________________

Current Medications (please list ALL prescription, over-the-counter, and herbal)

______________________________________________________________________________________________

Current Medical Equipment Needed

_____________________________________________________________________________________________

Page -2-

VACATION BIBLE CAMP 2019 Health and Emergency Information Form

Participant Name _______________________________

Safety Information Participants will have the opportunity to participate in OPEN SWIM where a certified Life Guard will be on duty.

Describe your child’s swimming ability: ☐ Non-Swimmer ☐ Beginner ☐ Intermediate ☐ Advanced

Initial __________ I give permission for my child to sleep on a top bunk.

Other concerns:

Illness or Accident at Camp: New Beginnings Christian Fellowship will make reasonable attempts to notify Parent/Legal Guardian/Emergency

Contact if a child becomes sick or sustains an injury in which general first aid is not sufficient and treatment by a

physician is necessary.

(Initial)___________ I give my permission to the staff administrator or nurse to administer Tylenol/

acetaminophen, ibuprofen, Benadryl, or over-the-counter antacids as needed.

Do you have an additional students attending?

1. Camper Name _______________________________ Grade ________ 2. Camper Name _______________________________ Grade ________ 3. Camper Name _______________________________ Grade ________ 4. Camper Name _______________________________ Grade ________

Page -3-

VACATION BIBLE CAMP

2019 REGISTRATION FORM, RELEASE, AND INDEMNIFICATION

STATEMENT OF UNDERSTANDING AND MEDICAL CONSENT

I, the undersigned parent or legal guardian of _______________________________________(the “Child”), have legal custody

of the Child, a minor, and give my consent for the Child to attend events being organized by New Beginnings Christian

Fellowship (“NBCF”). I understand that there are inherent risks involved in any NBCF ministry, activity, or athletic event and

that no degree of care or caution can completely eliminate these risks. I release and agree to hold harmless, defend and

indemnify NBCF and its directors, officers, employees, volunteers and agents (“Releasees”) from and against any and all claims

for personal injury (including loss of life) and all other losses or damages (except that Releasees shall not be released, held

harmless, defended or indemnified for the Releasee’s gross negligence or willful misconduct) that the Child or the Child’s

parent(s) may suffer as a result of the Child’s participation in or transportation to and from these ministries, activities, or

athletic events.

I acknowledge that the Child’s participation in the activities of NBCF Vacation Bible Camp is voluntary and may require

traveling and participation in physical exertion. The Child has my permission to participate without restriction in all NBCF

Vacation Bible Camp activities, which may include, but are not limited to the following: cookouts, camp fires, swimming,

zip line, hiking, soccer, volleyball, softball, basketball, Horses or Ponies, Challenge Course, High or Low Ropes Course, paint ball,

and Running. In consideration of the activity or event in which the Child is involved, I hereby represent and warrant that the

Child is physically and medically capable of fully partaking in any activity or event. IF CHILD DOES HAVE LIMITATIONS FOR

PARTICIPATION, PLEASE SPECIFY: ___________________________________________

I grant permission to NBCF and its employees, volunteers and agents to take the Child to a licensed physician for medical

treatment, emergency surgery, or hospitalization if the Child becomes ill or sustains an injury or otherwise requires medical

treatment or attention and NBCF cannot contact me within a reasonable period of time. I give my consent to any licensed

physician to administer drugs or medicine or to perform such medical procedures as that physician determines necessary for

the relief of pain or to preserve the Child’s life or health. I agree to assume the responsibility for all medical, transportation,

rescue and other related expenses incurred on behalf of the Child in the event the Child receives medical attention.

I grant permission to NBCF to use the Child’s name and/or photograph for use in publications such as newsletters, recruiting

brochures, pamphlets, website promotions, magazines, display boards, or other electronic forms of media, for the purpose of

promoting the vision, mission, or activities of NBCF and its subordinate entities.

I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in

conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or

other compensation arising from or related to the use of the photograph.

I agree to release, defend, and hold harmless NBCF and its directors, officers, employees, volunteers and agents, or any firm

publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and

against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any

misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may

occur or be produced in taking, processing, reduction or production of the finished product, its publication, or distribution.

By sharing my email address and phone number, I authorize NBCF to communicate information regarding Vacation Bible Camp

electronically and by phone.

This document contains a release and waiver of liability. Please read carefully before signing.

By my signature below, I acknowledge that information that I have provided on this form is correct and agree to the terms therein.

PARENT/LEGAL GUARDIAN SIGNATURE: _________________________________________ DATE: _____________

PRINTED NAME:

PARENT E-mail: ___________________________________________________

Page -4-

VACATION BIBLE CAMP 2019 Ministry Service / Church School Form

Each participant will be required to obtain the signature of either their Church School Teacher and/or

Ministry Leader. Vacation Bible CAMP is for our children and youth who demonstrate an earnest

investment in their spiritual development and stewardship in service.

Note: Participants will not be allowed to register without a signed ministry service or church school form.

Participant Name: ______________________________________ Cell Phone #: (______)____________________

Birth Date: _____/_____/______ Age: ______ Gender: ☐F ☐M Grade: _____ School:_____________________

Church School Class__________________________ 2018-2019 Attendance: Regular _______ Sporadic _______

Lead Teacher (Print Clearly)______________________________________________________________________

Signature__________________________________________________ Date____________________________

Ministry Name______________________________ 2018-2019 Participation: Regular ______ Sporadic _______

Ministry Lead (Print Clearly) ______________________________________________________________________

Signature__________________________________________________ Date_________________________

Agreement for Waiver and Release, Assumption of Risks & Indemnification (rev 1/10)

NOTICE: This document affects your legal rights, please read carefully. Handwritten changes to this

document are not permitted and will not be honored. This Agreement constitutes the entire Agreement and

shall not be modified except via written document, executed by both parties. If any portion of this

Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

Event Name

Participant Name Parent / Guardian Name

Date of birth: _________________ Sex_______ Age_______

Mailing address: City: State: ____ Zip

Home phone: (_______) Cell Phone: (_______)

Work phone: (_______) E-mail:

Emergency contact: Emergency phone: (_______)

Primary doctor: Phone: (_______)

Health insurance provider: Group policy #:

Policyholder: Policyholder’s #:

Please do not send me information regarding CRISTA Camps events.

I, the above Participant or the Parent/Legal Guardian of participant, being above the age of 18, agree as follows:

I acknowledge and understand that certain camping activities, including but not limited to: skating, skateboarding, paintball, ropes courses, archery,

marksmanship, water sports, horses and dirt bikes are hazardous and dangerous activities that require strenuous exercise and varying degrees of skill

and experience. I understand that these activities can result in serious injury to the person and damage to property and I voluntarily assume any and all

risks of loss, damage or injury while on the premises.

I acknowledge that there are risks, hazards and dangers of personal injury, death and disability inherent in entering camp grounds and participating in,

or viewing camp activities. I am aware that the usual risks, hazards and dangers of personal injury, death and disability increase when using certain

camping equipment and when other persons, whether of the same or different level or experience or skill, are using the same facilities and equipment.

In consideration for my participation, or for the participation of my child or the minor for whom I represent that I am legal guardian, I hereby release

and forever discharge Island Lake Camp, Miracle Ranch Camp, and CRISTA Ministries, and their servants, employees, officers, directors, trustees and

all other persons or entities acting on their behalf (collectively referred to as “CRISTA”), from any and all claims, actions, damages, liabilities, costs or

expenses and attorney fees which are related to, arise out of, or are in any way connected to my, my child’s, or the minor for whom I represent that I am

legal guardian’s viewing or participation in any camping activities. By signing this Agreement, it is my intention to waive any rights to sue or seek

damages from CRISTA; except where injury, death or disability results from CRISTA’s gross negligence.

I further agree to indemnify, hold harmless and defend CRISTA against any and all claims for damages, costs, expenses or attorneys fees brought by

any third party in connection with or arising out of my, or the above-listed participant’s involvement or participation. This Agreement shall be effective

and binding upon my marital community, estate, heirs, agents, personal representatives and assigns.

Emergency Consent: _____________________ (participant’s name) may receive emergency and/or routine medical care from a physician

or emergency facility if I am incapacitated (if participant), or cannot be reached in an emergency (if parent/guardian).

Photo Release: CRISTA may publish photos taken of participant and I release all rights to remuneration for such photos.

I hereby certify that I am over 18 years of age; I have carefully read the foregoing and acknowledge that I understand and agree to all the terms and

conditions. I have had the opportunity to ask any and all questions regarding this Agreement and the effect of the same. I am aware that by signing this

Agreement, I assume all risks and waive and release certain substantial rights that I have or possess.

Participant Signature (on behalf of marital community) _______________________________________ Date __________

Parent/Legal Guardian Signature (on behalf of marital community) ____________________________ Date __________

Additional Indemnification for Parents/Guardians – Must be completed for participants under the age of 18.

In consideration of _____________________’s (print minor’s name) (“Minor”) participation in Camps activities including the use of Camps

equipment and facilities, I further agree to indemnify and hold CRISTA harmless from any and all claims which are brought by, or on behalf

of Minor and which are in any way connected with such use or participation by Minor.

Parent/Legal Guardian Signature (on behalf of marital community) _______________________________Date_________