2025 Camp Registration

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Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Gender

Age

Does your child have any allergies or medical conditions?

List Allergies and or Medical conditions

your FOR medications?

Does your child take any medications?

List of Medications

AUTHORIZATION FOR TREATMENT

This health history is correct to the best of my knowledge, and the person herein named has permission to engage in all camp activities except as noted. I hereby give permission and authorize the medical provider selected by the Camp Director to secure or administer emergency medical treatment, including medical transportation and hospitalization and any other emergency medical procedures and services which may be needed for the person named herein. It is understood that this consent is given in advance of any specific diagnosis or treatment being required, and is given to encourage those persons who have temporary custody of the minor, and said medical provider or dentist to exercise their best judgment as to the requirements of such diagnosis or medical, dental or surgical treatment. In addition, I authorize camper to carry emergency medications and use as directed. I agree to remain fully liable and responsible for the payment of any such hospital, doctor, medical transportation, dental or medical fees. I further agree that in giving this permission and authorization, Circle of Faith Ministries does not assume any responsibility or liability for the payment of such hospital, doctor, medical transportation, dental or other medical fees which may be incurred. The completed forms may be photocopied and maintained by authorized personnel as needed including trips out of camp.

WAIVER OF LIABILITY

In exchange for participation in Circle of Faith Church Camp, I hereby agree as follows: I release and forever discharge Circle of Faith Ministries and Koinonia Farms from causes of action of any nature and kind, known and unknown, arising out of or relating to any injury, loss or damage to person and property that may be sustained as a result of participating in camp activities. I understand that my child’s participation in camp activities involves inherent risks, including risk of physical or psychological injury, pain, suffering and illness, and I assume all related risks and allow my child to voluntarily participate in camp activities. This Release shall be binding upon the parties and their respective heirs. This Release may not be altered, amended or modified, except by a written document signed by both parties. I have carefully read and fully understand all the provision of this Release and am freely, knowingly and voluntarily entering into this Release.

AUTHORIZATION FOR OVER-THE-COUNTER MEDICATIONS

In the event your child experiences minor discomforts during camp, we would like the opportunity to make your child as comfortable as possible. Therefore, below is a list of over-the-counter medications that can be administered by Circle of Faith Ministries personnel with your authorization. These medications are approved by the Circle of Faith Ministries Medical Director using the recommended doses from the manufacturers. The below approved medications are intended for occasional use only. I consent to the administration of the below indicated over-the-counter medications which will be available, at no charge, for all campers. Please make available the following medications to my child (check all that apply). If they are NOT checked they WILL NOT be given to the camper.

Photo consent

Check if you give Circle Of Faith Ministries permission to use your child's photo on our website or social media.