Arcadia Valley Daycamp Registration

Complete this form to sign your camper(s) up for daycamp

How many campers are you registering?

Parent/Guardian and Emergency Contact Info

We require a total of 3 people with phone numbers that we can contact in case of emergency

Parent/Guardian #1

Parent/Guardian #2 (Optional)

Are there any special circumstances (such as a custody battle) where one parent who should not pick up a child may try to do so?

At the end of the day, there is a check-out process and campers will only be released to adults who are listed on this form. The people you list as emergency contacts along with parents/guardians may pick-up your camper at the end of the day, if you are unable to do so.

Emergency Contact #1

Emergency Contact #2

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Medical Information

Should a medical emergency occur, we will attempt to contact the parent/guardian and if necessary the paramedics.

I understand that Dayspring Bible Camp, Bethel Community Church, and/or First Evangelical Free Church will not be responsible for the medical expenses incurred, but such expenses will be my responsibility as parent/guardian. I further release all participating parties from all liability associated with this camp.


Parent/Guardian Electronic Signature

Clear

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Wellness Pledge

We want camp to be a safe place for everyone, therefore we are asking that everyone make a commitment to only bring healthy campers to camp.


My camper(s) nor any member of their household and the person dropping them off at camp has not:

  • had a fever, dry cough, or difficulty breathing within the last 72 hours
  • been diagnosed with COVID-19 within the last 14 days
  • been knowingly exposed to anyone with COVID-19 within the last 10 days

My camper(s) have not had any of the following symptoms in the last 48 hours.

  • Cold/flu
  • Fever or chills
  • Persistent cough
  • Shortness of breath or difficulty breathing
  • Muscle or body aches
  • New loss of taste or smell
  • Sore throat
  • Green or yellow runny nose
  • Nausea or vomiting
  • Diarrhea
  • Rashes or skin eruptions
  • Discharge in or around the eyes (conjunctivitis/pinkeye)
  • Any contagious disease

I, as parent or guardian, commit to only bringing healthy campers to camp.


Parent/Guardian Electronic Signature

Clear

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Terms of Agreement

Photo Release

I hereby give permission for my child to be photographed during the Arcadia Valley Day Camp. I understand the photos will be used to share during video slideshow presentations and/or reports to our churches and for promotional purposes including flyers, brochures, newspaper, and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed. I do not expect compensation and that all photos are the property of Bethel Community Church.


Parent/Guardian Electronic Signature

Clear

I understand that DAYSPRING BIBLE CAMP, BETHEL COMMUNITY CHURCH, and FIRST EVANGELICAL FREE CHURCH carry medical and hospitalization insurance coverage which, consistent with the exclusions, limitations and terms thereof, may provide benefits over and above any personal medical and hospitalization coverages available to my family. I understand that any personal medical and hospitalization insurance available to my family will provide primary coverage and the ministry’s medical and hospitalization coverage (subject to the exclusions, limitations and provisions in medical coverages available to my family, in and, before applying for benefits may be available from the ministry’s medical and hospitalization coverage. I further understand that, in the event my child requires medical or dental treatment while engaged in camp, reasonable effort will be made to contact me; however, if I cannot be reached, I hereby consent and give permission to the ministry’s sponsor or any adult counsellor acting on behalf o the ministry with respect to camp, as agent for me, to consent to any X-ray examination; injections; anesthesia; medical, dental or surgical diagnosis and treatment; and hospital care and treatment advised and supervised by a physician, surgeon, or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either as an outpatient or in any hospital. To the best of my knowledge, I have listed above all of my child’s medical allergies, medications being taken, medical problems and other pertinent information. My child has permission to participate in all prescribed activities except as noted by me.


Parent/Guardian Electronic Signature

Clear

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Gender

Birthdate

Medical

Does this camper have any medical problems we need to be aware of? (Including any maintenance medication such as diabetes, asthma, or seizures)

Allergies

Does this camper have any allergies to food, insect bites/stings, or medications?

Medications

Will this camper need any medications at camp?

Should a medical emergency occur, we will attempt to contact the parent/guardian and if necessary the paramedics.

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