Please fill out form completely. Please put N/A for any field that does not apply. Registration is open to youth entering grades 6th - 8th.
Please fill out this section as completely as possible. Attendies are not singled out, made to feel embarrassed or treated differently because of information gathered from the health form. Rather, the more we know ahead of time, the easier it is to help your child have a successful experience during youth activities. This information will be shared with Church and group leaders, in addition to any medical facility if necessary.
Medications & Restrictions
Unless specific instructions are provided, camp health care staff will treat minor illnesses with over the counter medications. If illness persists, parents will be notified.
Please know that we value your privacy. Health history information is available only to the church leaders, director, and youth leader (if necessary). The more information you provide, the better we can serve them!
Medical Disclosure: My child has permission to engage in activities except as noted above. I give permission for forms to be copied for activities. The information provided on this form is accurate to the best of my knowledge. I have indicated any special health conditions, including required medication and activity limitations which should be known to the staff and medical personnel. I hereby give permission to medical personnel selected by the youth leader to seek emergency treatment for the minor including necessary transportation for my child if necessary. I agree to accept financial responsibility for the costs related to this emergency treatment. In the event I cannot be reached in an emergency, I hereby give permission to medical personnel to secure and administer emergency medical treatment, including hospitalization for my child. By typing my name below and clicking SUBMIT, I agree to the terms and conditions stated above
Laramie Valley Chapel and leaders assume no liability for loss or damage to personal property. We, the undersigned Parent/Guardian of camper, hereby fully release and discharge Laramie Valley Chapel and all employees and persons whomsoever directly or indirectly liable from any and all claims or demands, damages, costs, property damage, injuries, or death related to any and all activities associated with the activity. We, the undersigned, are aware of all risks related to activities in and around youth events. I do hereby affirm that I have read the release statement and acknowledge this release as contractual, containing the entire agreement between parties, to which is also binding upon my heirs, devises, executors, administrators, and successors in interest. By electronically signing this document, and clicking SUBMIT, I agree to the terms and conditions stated above.
Please read confirmation email to complete registration fee. The cost per child is $99. Thank you!
