LIT Retreat

1Camper Information

2Waiver

3Parent Permission Form

4Payment

LITs Name *

First

Last

Sex *

Male
Female

Age (at the start of camp) *

Birthday *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Guardian's Primary Phone # *

Guardian's Secondary Phone #

i.e. Other guardian's number, home phone, etc.

Email *

Confirm Email

Guardian Name *

First

Last

Guardian Name

First

Last

Guardian Signature *

Clear Signature

Medical Infomation

Care Card Number *

Alternate Contact Name *

First

Last

Someone other than the campers guardian(s)

Relation To Camper *

Alternate Contact # *

Any Allergies? (other than food) *

If Yes, Please Explain

Special Dietary Needs? *

If Yes, Please Specify

Any Extra Supervision Needs? *

Are there any reasons the camper may need extra assistance? Are there reasons that during activities (including water sports) in which the camper cannot participate, due to health or disability?

If Yes, Please Specify

Informed Consent and Assumption of Risk Agreement

IN CONSIDERATION of being permitted to participate in any way at Maple Springs Bible Camp, (hereafter known as ministry point) operated by One Hope Ministries of Canada , I acknowledge, understand, and agree: 1. Participation in activities could result in possible personal injury. Despite precautions taken by the ministry point, accidents and injuries may occur. By signing this form, I assume all risks related to the use of any and all spaces used by the ministry point. 2. To release from responsibility, the ministry point, including all missionaries, full-time and part-time, paid or volunteer, and the facilities used from any cause of action, claims, or demands now, and in the future that might arise out of the participant’s participation in activities at the ministry point or from the physical risks associated with the activities. 3. I accept all risks relating to such activities including personal injury such as: cuts, sprains, scrapes, bruises, fractures, broken bones, concussions, death, or any personal property damage/loss, which may occur on the camp premises. I understand these risks and will not hold the ministry point liable for any such injury. 4. Furthermore, I agree to obey all ministry point rules and take full responsibility for my behaviour in addition to any damage I may cause to the facilities utilized by the ministry point. *

Yes, I have read the above information

Participants Name (if 13 years and older) *

First

Last

For Participants of Minority Age (under 18 at the time of registration)

Guardian Signature *

Clear Signature

Date *

Guardians Phone # *

Parent/Guardian Permission Form - Please Read Prior To Registering

*Initial *

Clear Signature

In case of emergency, I understand every effort will be made to contact me. In the event that I cannot be reached in an emergency situation, I hereby give permission to licensed emergency and health care personnel to provide treatment, services and transport necessary to maintain the health of my child. In the event medication, medical advice, treatment and/or equipment are required, I agree to accept financial responsibility for fees in excess of provincial and or private medical insurance. I agree that the information on this form may be disclosed to such emergency and health care personnel. In the event of illness, accident, emergency, or any other circumstance requiring medical treatment, such treatment may be procured for the participant without legal or financial obligation to Maple Springs Bible Camp and One Hope Canada. All known health issues of my child have been stated to the camp. I will notify the camp if my child is exposed to any infectious diseases prior to arriving at camp.

*Initial *

Clear Signature

I agree to allow photographs or video of camp activities, which may include my child, to be used in any and all camp promotional material including the sharing of photographs and videos with ministry partners of One Hope Canada.

*Initial *

Clear Signature

I have read and understood the terms of this agreement and BY ALLOWING MY CHILD(REN) to participate in the camp, I am voluntarily agreeing to abide by these terms. I confirm that the participant [my child] is physically and mentally able to participate in all activities of the camp, unless specifically indicated otherwise in writing.

*Initial *

Clear Signature

Maple Springs Bible Camp reserves the right to request any participant to withdraw from their camp if the participant is not acting in an appropriate and responsible manner.

LIT Retreat *

Price: $85.00

Optional Purchase

Merchandise

Hoodie - $50.00
Crewneck - $50.00

Adult sizes M-XL (hoodie)

Hoodie Size *

understand *Initial Alternate

Crewneck Size *

Donation

We greatly appreciate our cabin leaders and missionary team. Here, you give a financial gift that will go towards the people making camp happen for your campers! Any donations above $50.00 will receive a donation tax receipt! Thank you so much for your support!!

Total

$0.00