Kid's Day Camp

Default Title

And he awoke and rebuked the wind and said to the sea, “Peace! Be still!” And the wind ceased, and there was a great calm. ~Mark 4:39

Miriam's Hope Ranch Day Camp: June 17-24, 2024

* Parent's Name

* Address

* City

* State

* Zip Code

* Phone

* Emergency Contact

* Emergency Phone number:

* Child's name (Child 1)

* Age

* Birthdate

* Grade entering in the fall

* Grade entering in the fall copy

* T-shirt size

Child's name (Child 2)

Age

Birthdate

Grade entering in the fall

T-shirt size

Child's name (Child 3)

Age

Grade entering in the fall

T-shirt size

Child's name (Child 4)

Age

Birthdate

Grade entering in the fall

T-shirt size

Do any of your children have a medical condition? Please list

Do any of your children need special accommodations? Please list

Do any of your children have allergies/food allergies? Please list

* Person authorized to pick children up?

* I give permission to Miriam’s Hope to use my child’s/children's picture in promotional material.

Note: We will be playing outdoors and on a few days with water so please wear tennis shoes and no need to bring cell phone.

I acknowledge that participation in the activity described above involves risk to the participant (and to the participant's parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.

In consideration for the opportunity to participate in the activity described above (the "activity"), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the "activity sponsor").

Further, the participant ( or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.

If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

By typing your full name here you acknowledge this will be used as your signature.

* Signature

* Date:

The suggested donation for the camp is $40 per camper and all campers must be registered by May 1st. You will have the options to pay after you submit this form.

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