LIT Applicant's Name *

Separate application form required for each youth

First Name

Last Name

Birthday *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home or Cell Phone *

(###)

###

####

MEDICAL INFORMATION: If you have a child(ren) with Medical Conditions e.g. Asthma; Allergies, or requires medications that may need be administered at Camp e.g. Inhaler, indicate child's name and condition below. If a child in your family requires EA Support, DO NOT include them on this registration see the "Interest for Camper Support Form." for more details.

YES, we have medical listed below.

NO, there is no medical information to share

Medical Release *

I, the parent or legal guardian of child(ren) listed above, a minor, by submitting this health card number, hereby authorize and give permission to the physician or medical practitioner, selected by Mountainview Christian Reformed Church to hospitalize, secure proper treatment including but not limited to the prescription of medications, diagnostic studies, and any other medical procedure for my child)ren) as deemed necessary by the physician under the circumstances. It is understood that this authorization is given in advance of any specific medical treatment being needed, and is given to provide authority to the physician to render that care which in exercise of his or her best judgment is advisable.

I agree.

Camp LIT Program Options *

The Leader in Training Program is offered in 2 weeks sessions. Please select which session you are signing your youth up for.

Weeks of July 7-11 and July 14-18; Session 1 FULL - email camp@mountainviewcrc.org to be added to the wait list.

Weeks of July 21-25 and Jul 28 - August; Session 2 FULL - email camp@mountainviewcrc.org to be added to the wait list.

Session 3: Weeks of Aug 4-8 and Aug 11-15

Code of Conduct (available in large print on the Camp page) *

At Mountainview Kids Camp, it is our hope to create a fun, safe, and respectful environment for all our Campers. Everyone deserves an awesome camp experience! It is for this reason our Camp team always keeps a close watch on any unkind behaviours such as teasing or bullying which may affect another Camper’s experience. LIT's must: • Be able to take instruction and follow direction from our Camp Director and Camp team leaders. • Not behave in a manner that negatively affects another Camper’s experience. • Understand that they may not physically or verbally hurt others, and they will respect the feelings & safety of themselves and others. • Respect camp property and/or another Camper’s property. Parents/Guardians will be responsible to pay for any damages deliberately caused by their child by defacing or damaging property. Behaviour deemed inappropriate & unkind includes: • Leaving the instructed boundaries unless accompanied by a Camp team member. • Threatening behaviour, bullying, offensive or insulting language, verbal or physical abuse to other Campers, Camp staff and guests. • Borrowing of other’s possessions without their consent. • To be in possession of a weapon or implement that Camp staff deem dangerous or potentially dangerous. • Any illegal activity. Should there be any concerns with behaviour, the Camp Director will communicate immediately with the parent/caregiver. Though certain scenarios might require a unique behaviour plan, for most situations, if a LIT is unable to participate respectfully and engage with kindness, the LIT will no longer be able to participate in Mountainview Kids Camp.

This information has been read and understood, as indicated by my check mark.

Media Consent

I agree that photos may be taken of my child at Mountainview Kids Camp and may be used in the promotion of Mountainview Church. They may be published or used for any application in newspapers, videos, posters, slide presentations, FaceBook, YouTube, other social media and networking sites or otherwise displayed to the public—either in whole or in part by Mountainview Church.

Yes

No

Release and Waiver of Liability *

I/We, the parent(s) or Guardian of the above mentioned youth, in consideration of my/our child being permitted to enter the Mountainview Christian Reformed Church (hereafter Mountainview CRC) property, and being permitted to participate in Mountainview CRC activities and events, AGREE TO WAIVE, RELEASE, DISCHARGE AND COVENANTS NOT TO SUE, its employees, officers, directors, servants and agents from all liability to the child, to myself, or any personal representative of either, assigns, heirs, and next of kin, for any and all claims for damages, for death, personal injury or property damage, suffered by me or my child while participating in any Mountainview CRC event or activity. I/WE UNDERSTAND THAT THIS RELEASE AND WAIVER OF LIABILITY applies to any claims occurring from injury to person or property, whether caused by negligence of Mountainview CRC or otherwise. I/We acknowledge that the intent of this RELEASE AND WAIVER OF LIABILITY is to prevent Mountainview CRC from being held liable for injuries to person or property, and that selecting YES constitutes my/our agreement and the agreement of the child listed above, not to hold Mountainview CRC responsible for any damages, losses, injuries to person or property, as a result of any negligence or other wrongful conduct on the part of Mountainview CRC or on the part of other third parties. I/We ALSO AGREES TO INDEMNIFY AND HOLD HARMLESS Mountainview CRC from any loss, liability, damage, or cost that Mountainview CRC may incur due to the presence of myself or said child, upon Mountainview CRC premises or in any way using any of Mountainview CRC facilities or attending any events of Mountainview CRC, whether caused by negligence of Mountainview CRC or otherwise. FURTHER, I/WE EXPRESSLY AGREE THAT THIS RELEASE AND WAIVER OF LIABILITY is intended to be as broad and inclusive as is permitted by the law in the Province of Ontario. If any portion is held to be invalid, it is agreed that the balance shall continue in full legal force and effect. I/We further agree that this Release and Waiver of Liability shall be valid for the program season or year. I/We have read and voluntarily agree, and further acknowledge that no oral representations, statements, or inducements apart from the written agreement have been made.

Yes, I agree

No, I do not agree