Camp registering for: Lakeside WIT (Wrangler in Training)


Camper: Birthday:
Gender: Male Female
T-Shirt Size: Going into Grade:
Parent/Guardian
Email:
Retype Email:
Phone including area code (Numbers only please): Secondary Phone:
Mailing Address:
City: State: Zipcode:

Please select the first 3 weeks that you would like to work by order of preference

(Please note that weeks 4 & 5 are considered alternate weeks if the week you requested is full)

*Please note that final schedules will be confirmed by email

Preference Week to work
#1
#2
#3
#4
#5

Please list any friends you would like to work the same week as:

Help us get to know you by answering these questions:

Do you have any hobbies or play any sports?

What school do you go to?

Have you ever had a job before? (Babysitting, yard work, etc?)

Do you have any experience with horses? Please describe

If you attend church or a youth group regularly, what church do you attend?

What do you believe about the Bible?

What do you believe about who Jesus is?

What do you believe about Prayer?


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.



Health Form

Emergency Contact:
Phone 1 Phone 2

General Health Questions

Any recent injury or illness?
Frequency ear infections?
Any Skin Problems?
Problems with sleepwalking?
A Chronic or Recurring Illness?
Wear glasses or contacts?
An orthodontic appliance?
Mono in last year?
Any current medications?
Frequent Headaches?
Frequent stomach aches?
A head injury?
High blood pressure?
Asthma?
Emotional difficulties for which professional help was sought?

Seizures?
Diabetes?
History of bed wetting?
Immunizations out of date?


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:



* Any medical information that needs to be discussed with the medical staff, please see them during camp registration