Camp registering for:Wilderness High School Sea Kayak CampBusride*: No bus ride needed Round-Trip $60 One-way to Camp $35 One-way to Anchorage $35 *The bus will depart from and return to the Duluth Trading Company parking lot at 8931 Old Seward Hwy., Suite A Anchorage, AK 99515. The exact times will be sent you in your confirmation email or letter. Camper: Birthday: Gender: Male Female T-Shirt Size: None Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL Going into Grade: None Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Adult Parent/Guardian Email: Retype Email: Phone including area code (Numbers only please): Secondary Phone: Mailing Address: City: State: Zipcode: Parental Agreement for Waiver and Release, Assumption of Risks & Indemnification I acknowledge and understand that while attending Solid Rock Bible Camp of Soldotna, Alaska (SRBC), my child may be involved in various activities, including but not limited to: archery, pellet guns, boating, waterskiing/wakeboarding, swimming, the blob, rope swing, obstacle course, horses, mountain boards, climbing wall, hiking, games, climbing on the Rock, and other activities. I understand that these are hazardous and dangerous activities that can result in serious injury to the person and damage to property and I voluntarily assume any and all risks of loss, damage or injury during participation in SRBC programs and activities, whether on or off Camp grounds. I acknowledge that there are risks, hazards and dangers of personal injury, death and disability inherent in entering camp grounds and participating in, or viewing Camp activities. I am aware that the usual risks, hazards and dangers of personal injury, death and disability increase when using certain camping equipment and when other persons, whether of the same or different level or experience or skill, are using the same facilities and equipment. In consideration of SRBC allowing my child to attend for the period specified below and to participate in the activities of the Camp, I do hereby grant permission for the child to participate fully in Camp activities. I hereby release and forever discharge SRBC and Solid Rock Ministries, Inc., and their staff, employees, officers, directors, and all other persons or entities acting on their behalf, from any and all claims, demands, actions, damages, liabilities, costs or expenses and attorney fees which are related to, arise out of, or are in any way connected to my child’s viewing or participation in any camping activities, whether such an injury occurred on or off Camp property. By signing this Agreement, it is my intention to waive any rights to sue or seek damages from SRBC; except where injury, death or disability results from SRBC’s gross negligence. I further agree to indemnify, hold harmless and defend SRBC against any and all claims for damages, costs, expenses or attorneys fees brought by any third party in connection with or arising out of my, or the my child’s involvement or participation. I further agree to indemnify and hold harmless SRBC from any and all claim which are brought by, or on behalf of my child and which are in any connected with such use or participation by my child. This Agreement shall be effective and binding upon my marital community, estate, heirs, agents, personal representatives and assigns. If any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. Photo Release: SRBC may publish photographs or video taken of participant in print and online and I release all rights to remuneration for such photos/videos. I hereby certify that I am over 18 years of age; I have carefully read the foregoing and acknowledge that I understand and agree to all the terms and conditions. I have instructed my child to obey the rules of SRBC. I affirm that my child does not have any medical condition which might create a risk of safety for them or for others who are participating in the camp activities and programs. I have had the opportunity to ask any and all questions regarding this Agreement and the effect of the same. I am aware that by signing this Agreement, I assume all risks and waive and release certain substantial rights that I have or possess. I do not agree agree to the above statements by signing below Clear Undo Health Form Emergency Contact: Phone 1 Phone 2 General Health Questions Any recent injury or illness? No Yes Frequency ear infections? No Yes Any Skin Problems? No Yes Problems with sleepwalking? No Yes A Chronic or Recurring Illness? No Yes Wear glasses or contacts? No Yes An orthodontic appliance? No Yes Mono in last year? No Yes Allergies? No Yes Any current medications? No Yes Frequent Headaches? No Yes Frequent stomach aches? No Yes A head injury? No Yes High blood pressure? No Yes Asthma? No Yes Emotional difficulties for which professional help was sought? No Yes Seizures? No Yes Diabetes? No Yes History of bed wetting? No Yes Immunizations out of date? No Yes Please explain any "Yes" answers from above Carrier Policy Number Family Physician Phone Number Family Dentist Phone Number Essential Medical Information For the safety of everyone in camp and to comply with regulations, all medication will be stored in the Health Center All prescription medications and over-the-counter (OTC) FDA approved medications must be in the original containers with the camper’s name and how it is to be given. Please do not send homeopathic meds (such as melatonin), as Alaska law does not permit us to give them. Vitamins will only be given with a doctor’s order. Inhalers and EpiPens need a prescription label. A few OTC meds are kept in the nurse’s office and provided for campers as needed, such as Tylenol, Ibuprofen, Tums, Benadryl, Robitussin, and Zyrtec, per our Standing Order Physician. Phone calls will be made to parents and/or physicians concering any medications about which there are any questions. SRBC’s food service does not provide specialized diets, however we do try to provide healthy options for campers to choose. Campers with dietary restrictions or needs are welcome to bring their own food. Please consult the nurse. Permission to provide necessary treatment or emergency care I, hereby give permission to the medical personnel selected by Solid Rock Bible Camp to give OTCM per our standing order physician and administer treatment to my child, and if the need arises, provide transportation to a medical provider or call 911 for EMS response. I give permission for medical care by a health provider or emergency care including hospitilization, x-rays, routine tests treatment, and release of records necessary for insurance purposes. I also give permission to share health information on an as need to know basis to camp staff. This completed form may be photocopied for trips out of camp. Parents will be notified in the case of an emergency or the need for outside medical care arises. Signature: Clear Undo * Any medical information that needs to be discussed with the medical staff, please see them during camp registration Payment:Workcrew Code: Note: Your registration is not valid until the $50 non-refundable registration fee is received unless you are workcrew*. (This $50 DOES go towards the cost of the camp) You must pay $50, or pay the full amount of the camp, unless you a are registering for the waitlist then you don't have to pay a registration fee. Any remaining amount will be due the day of registration. *If you are workcrew please enter the code received in your email and after registering in the box above and your registration will be allowed. Amount to pay*: $50 $559559 $0 Registering for waiting list *Disregard this section if are workcrew and have put in your code. Use a credit card: Name on Credit Card: Billing Address: Same as above City: State: Zipcode: Credit Card # Verification Code: Expiration: Pick 01 02 03 04 05 06 07 08 09 10 11 12 / Pick 2019 2020 2021 2022 2023 2024 2025 2026 2027 OR Send a check Please make checks out to Solid Rock Bible Camp and send to 36251 Solid Rock Road #1, Soldotna, Alaska 99669, with campers name in the memo.