Summer Camp Permission Form

Summer Camp Permission Form

This form is to be filled by the parents or guardian to give their children a permission to join the summer camp. If you are organizing an event like this, use this form so the parents of the attendee will be able to sign and authorize their children. Form Preview
Challenge Summer Camp Permission Form
  • Summer Camp 2017 Permission to Participate in Activities: RC Activities Inc.

  • Nature and duration of activities

    Summer camp at Potters Ranch in Union Kentucky for rising 5th to 8th graders June 18-22. Activities include camp activities like zipline, creeking, rockwall, team time, sports, spiritual activities.

    Team Leaders attend 3 day training from June 15th to June 18th and also are group leaders and participate in camp activities from June 18-22.

  • 1. Activity Supervisors

    Consecrated women of Regnum Christi, Mom chaperones, college-aged volunteers.
  • 2. Transportation

    Participants are responsible for securing their own rides to and from Potters Ranch. Adult volunteers and chaperones will transport the participants to Big Bone Lick State Park up to 4 times during camp.
  • 3. Mentoring

    Participants may be offered mentoring, which is intended to help young people personalize the principles of Christian living that they receive at home and in club activities. Mentoring involves a private conversation with an adult conducted in plain view of others. When dealing with adolescents, confidentiality will be maintained to foster openness of dialogue, but situations involving sexual abuse of a minor or threats to life or physical health will be reported to the appropriate authority and to the parents (except in those cases where the parent may be the alleged abuser).
  • 4. Requirements

    The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section above.
  • 5. Consent

    I hereby attest that I am (we are) the legal parent\guardian(s) of the above-named child and hereby consent to the child's participation in the activities described above. I understand that activities of the kind described above may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.
  • 6. Insurance

    I/We understand that RC Activities,Inc. does not carry any insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my own insurance carrier; or (b) that I/We am personally financially responsible for any and all medical costs incurred as a result of the child's injury.
  • 7. Emergencies

    If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to and authorize the above-named activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).
  • 8. Release and Identification

    I/We release and waive, and further agree to indemnify, hold harmless or reimburse RC Activities, Inc.and Consolidated Catholic Administrative Services, Inc. the individual members, agents, employees and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys' fees incurred by RC Activities, Inc and Consolidated Catholic Administrative Services, Inc.or any of its individual employees, agents, volunteers, etc in enforcing this indemnity provision) without limitation in time or amount, damages or injuries arising out of, during, or in connection with my/our child's participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any.I/We unserstand that this release and indemnification shall surviv the end of my/our child's participation in the activities referenced on this form and shall have no limitation in time or amount.
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  • 9. Authorization

    I/We hereby authorize RC Activities, Inc. to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by RC Activities, Inc. in its promotional materials and for its promotional purposes associated with its nonprofit activities. This authorization shall extend to use of my/our child's image and likeness on the website of RC Activities, Inc. or its successor in operation of affiliated organization(s) upon written consent of RC Activities, Inc. I/We understand that this authorization shall survive the end of my/our child's participation in the activities referenced on this form.
  • 10. Emergency Contacts

    If, in the event of a medical or other emergency, I am unable to be reached by telephone at my home or work telephone numbers listed below, I authorize the activity supervisor(s) to attempt to contact me through the emergency contacts listed below.
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  •  -  - Pick a Date
  • **Note: Chaperones must be Virtus trained. You can check more than one box. Chaperoning implies spending the night at camp.

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