Camper’s Name:________________________________________________________

2018 Union Bible Camp

Registration/Consent and Release Form (under 18 years of age)
I promise to obey the rules and regulations and will cooperate with all leaders and campers.

Church Name

Pastor’s
Name/Contact info

Camper’s Name

Address

City/State/Zip

Birth Date

Grade Completed

Gender Male Female

Shirt Size: YS YM YL AS AM AL AXL AXXL

(circle one)
Parent/Guardian
Name (s)
Home Phone # Work Phone #

Cell Phone # Cell Phone #

Email

Emergency Contact Relationship to camper

Emergency Contact # Emergency #

OFFICE USE ONLY

AMOUNT PAID________ PAYMENT TYPE_________ CHECK#_________

Camper’s Name:________________________________________________________

____________ by checking here, consent is given to this child/youth to participate

in zip-line activities.

I would like my child excluded from the following activities:

__________________________________________________________________

My child is allowed to participate in water activities under the following

guidelines:
________No floatation devise needed in any depth water
_________Floatation device needed in water above 3’ (camper shall supply own safety equipment)
________ Floatation devise needed in all water depths (camper shall supply own safety equipment)
__________My child should not participate in swimming activities

Photo Release
I give permission to the Union Bible Camp staff to photograph my child for the camp’s social
media accounts. Names of those included in the pictures will not be used to identify the children.
_______Yes, I do give permission for my child to be photographed.
_______No, I do NOT give permission for my child to be photographed.

________________________________
Parent Signature
Camper’s Name:________________________________________________________

I, undersigned parent or guardian, hereby consent to my child/youth, participating in a camp/retreat/activity, to include but not
limited to, low ropes course team building, swimming, zip line, climbing wall, archery, fishing, all field and gym sports and
hiking at the Oaks Retreat Center. I further understand that activities might involve interaction and involvement with members of
the opposite sex. Details for specific events can be obtained at check in.

In consideration for being accepted by The Oaks of Greeneville, TN for participation in any activities or events sponsored by The
Oaks. I being 18 years of age or older, HEREBY RELEASE, FOREVER DISCHARGE, AGREE NOT TO SUE, AND AGREE
TO HOLD HARMLESS Union Bible Camp directors and staff, Union Association of Free Will Baptists, The Oaks and its staff,
Board, employees or agents thereof, from any and all liability, claims, demands, or judgements for personal injury, sickness,
death, as well as property damage and any expenses of any nature whatsoever which may be incurred by me and/or my child
while participating in any activity or event with The Oaks.

By my or my child’s participation in any such activity or event, I acknowledge that the participant has my permission to
participate and I agree that this Release shall be valid and binding as to all such activities/events participated in, unless I give
written revocation of such Release. Furthermore, I (and on behalf of my child if applicable), hereby assume all risk of personal
injury, sickness death, damage and expense as a result of participation in recreation, work activities, or other activities involved
with any such activity/event. Further authorization and permission to furnish any necessary transportation, food and lodging for
the participant.

I further agree to hold harmless Union Bible Camp directors and staff, Union Association of Free Will Baptists, The Oaks and
staff, Board, employees or agents from liability sustained by The Oaks as a result of the negligent, willful or intentional acts of
myself and my child, if applicable, including any expenses incurred attendant thereto.

I understand that general medical care and the administration of medicine is provided by trained members of the organization
staff. Emergency care will be sought when necessary.

I understand that part of the camping experience involves activities and group living arrangements and interactions that may be
new to my child, and that they come with certain risks and uncertainties beyond what my child may be used to dealing with at
home. I am aware of these risks, and I am assuming them on my behalf of my child. I realize the no environment is risk free, and
so I have instructed my child on the importance of abiding by the camp’s rules, and my child and I both agree that he or she is
familiar with these rules and will obey them.

I further give permission and consent to Union Bible Camp staff for any photographs, videos, and interviews to be taken during
the camping session to be published and used to illustrate, report, promote, and advertise the camp including internet web sites
promoting or reporting on the camp. I hereby assign full copyright of these photographs to Union Bible Camp with the
reproduction either wholly or in part. I agree that they can be used separately or together, either wholly or in part, in any way or
any medium. Provided my name is not mentioned in connection with any other statement or wording which may be attributed to
me personally. I undertake not to prosecute or institute proceedings, claims or demands against Union Bible Camp of any of their
staff related to any actions of the Union Bible Camp taken in accordance with this paragraph.

If the participant has not attained the age of 18 years, I hereby represent that I am the parent or legal guardian of this participant,
and as such hereby grant my permission for this child to participate fully except as stated in any such activity/event stated herein
and hereby give my permission to take said participant to a physician or hospital and I hereby expressly authorize and grant
Union Bible Camp and its supervising leader the right and power to authorize any necessary medical treatment for said child, and
I expressly assume all responsibility for any medical bills incurred. Further, should it be necessary for the child participant to
return home due to medical reasons, disciplinary action or otherwise. I hereby assume all transportation costs.

I further state that I HAVE CAREFULLY READ THE FORGOING RELEASE AND KNOW THE CONTENTS THEREOF
AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a binding agreement, which I have read and understood.

Signature of parent/guardian:___________________________________________________

Date:______________________

Camper’s Signature:__________________________________________________________

Date:______________________
Camper’s Name:________________________________________________________

Medical Information Form

Camper’s Name

Allergies

Height and Weight

Date of last
Tetanus shot
Medical Insurance
Information
Medical Insurance
ID
*Please attach a copy of your insurance card to be used in case of emergency.
_________ I give permission for my child to be administered over the counter medication when
necessary from Union Bible Camp staff. Over the counter medication will be provided by Union
Bible Camp Staff.

_______________________________ ___________________________
Parent/Guardian Signature Date

***PERSCRIBED MEDICATIONS MUST BE BROUGHT IN ORIGINAL, LABELED CONTAINER***

Name of Medication

Reason for medication

Amount to be given

When to be given

Discontinuation date

Other
Camper’s Name:________________________________________________________

Name of Medication

Reason for medication

Amount to be given

When to be given

Discontinuation date

Other

Name of Medication

Reason for medication

Amount to be given

When to be given

Discontinuation date

Other

Your signature verifies that your child may receive the above medications as indicated.

______________________________________________ _________________________
Parent/Guardian Signature Date

Medication picked up by:

________________________________
Camper’s Name:________________________________________________________

________________________________