Do you plan to apply for a scholarship?

Is this the first year the camper has attended a Disciples church camp?

Is this the first time the camper has been away overnight alone?

THE NEXT THREE QUESTIONS ARE TO BE COMPLETED BY THE CAMPER

The best thing that happened to me in the past year was ...

The low point of the last year was ...

Have you had any major changes in your life this last year?

Updates about camp are sent via email. Please list an email that is checked regularly.

Please provide the information below.  If the address is the same as above for the camper, there is no need to input that information again.  We MUST have an emergency phone number for the primary parent/guardian.

If the camper requires medical treatment while at camp, your family's or camper's health insurance information will be used at the hospital.  Please provide that information below.

"Medication" is any substance a person takes to maintain and/or improve their health. This includes vitamins & natural remedies. All medications are collected, stored, and distributed by either a volunteer adult with a health care background or by camp health care personnel.

Please list ALL medications (including over-the-counter or non-prescription drugs) taken routinely. Bring only enough medications to last the entire time at camp.  Keep the medication in the original packaging/bottle that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration.

Please check the appropriate box below to indicate IF the camper Will Not or Will take medication during camp.

Are the camper's immunizations/vaccinations up to date?

Has camper been fully vaccinated for COVID-19?

How many doses of vaccinations and boosters?

Check all that apply to the camper:

Please provide a brief description for any item you checked

Other than "camper is in general good health," please provide information about any item(s) you checked

What have we forgotten to ask?  If your explanation about the camper's health exceeded the space above, please provide additional information about the camper that you think is important or that may affect the camper’s ability to fully participate in the camp program via email to Leanne Stump ([email protected]) or call: 925-323-3184.  Include techniques and strategies for success at camp.

The undersigned person represents that he/she is the custodial parent/legal guardian of the above identified registrant and give my consent for my child/youth registrant to attend and participate fully in Summer Camp 2022 at the Community of the Great Commission.  I hereby voluntarily and absolutely release and discharge Christian Churches of Northern California and Nevada (hereinafter referred to as CCNC-N) and United Camps, Conferences and Retreats (hereinafter referred to as UCCR), its constituent organizations and their officers, agents, employees, including volunteers, from any and all loss or damages or actions or causes of action for personal injury, property damage, or wrongful death that my child may suffer as a result of his/her participation in the above-mentioned activity, including transportation to or from the event, or occurring by the use of facilities or equipment; whether or not such injuries or damages are caused by the negligence (active or passive) of any of the entities or individual named above.  

In case of medical emergency, I/We understand that every effort will be made to contact a parent or guardian of the camper. In the event I/We cannot be reached,  I/We give permission to the physician selected by the Camp Director, Camp Medical Care Provider, or other authorized camp staff member to secure proper treatment for, hospitalize and order injection, anesthesia or surgery for my child/myself (if over 18).  It is understood that this authorization is given in advance of any specific diagnosis treatment, or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) especially in case of emergency, to give specific consent to any such diagnosis, treatment, or hospital care which the aforementioned physician in the exercise of his or her judgement may deem advisable.  I agree to pay for any medical, dental, surgical, or hospital diagnosis, treatment, or care rendered to my child/myself (if over 18)
I promise that I (or an emergency contact person) will be available by phone and in person in case of an urgent situation during the week of camp.

I/We authorize the camp director or medical supervisor to dispense non-prescription drugs (i.e. Tylenol; ibuprofen) if the situation warrants to my/our child/youth.

I/We understand and accept that if the camper exhibits Covid-19 symptoms as described by the CDC, that The camper will be sent home from camp. I/We will follow the process outlined in the Region's Covid-19 Summer Camp procedure and obtain a Covid-19 PCR test and report the findings.

The camper has no physical or mental disabilities that would impair their participation except as noted above. I/We understand that the information provided on this form will be kept confidential and shared only as necessary to provide care for the camper.

I agree to abide by any and all special COVID Nonpharmaceutical Interventions (NPI) deemed appropriate by the Outdoor Ministries Committee during in-person camps. These will include but not be limited to wearing approved mask types, maintaining physical distances, frequent hand washing/sanitizing, smaller group and cabin sizes, being outdoors for most activities, providing optimum ventilation, as well as alternate bathroom and dining protocols as implemented by camp Directors.
I agree to respect and take care of the grounds and buildings of C.G.C.
I understand that I (or my parents) will be held financially responsible for any damages I cause.
I will not bring food or gum, as they attract and are harmful to wildlife.
I agree to respect and take care of my fellow campers.
I will not use offensive language.
I will not engage in disrespectful, abusive or violent physical or verbal behavior toward others.
I will not bring weapons or fireworks to camp.
I will not enter any cabin other than my own. I will respect the personal items of other participants and respect the personal space and other person’s physical autonomy.
I agree to respect and take care of myself.
I will not bring or use illegal drugs or alcohol.
I will not bring or use tobacco products, E-cigarettes, or vapor cigarettes. *
I will bring and take all medications regularly taken for success in group learning situations.
I will check in all prescribed and over the counter medications and vitamins listed on my health form to the health supervisor upon arrival. Any medications or vitamins brought to camp that are not listed on the health form must be signed in by a parent or guardian and checked in with the health supervisor upon arrival. Medications or vitamins found in the possession of a camper will be grounds for being sent home.
I will not engage in sexual behavior.
I will not hike alone, but remain with my small group, cabin group, or the large group at all times.
I agree to respect and trust the adults and understand that they are present for my safety, for my questions about life and faith, and that they are responsible to uphold the Region’s policies and boundaries as well as that of the camp facilities.
I agree to help make camp the best it can be.
I will not bring valuables and will turn in to the director, ALL electronic equipment, including cell phones, gaming devices, MP3 players, i-pods, droids, etc.
I will use the phone only in case of emergency and with permission of the director.
I understand that visitors and pets are not permitted.
I understand that late arrivals and early departures are not permitted.
I will remain on site for the duration of camp and will participate fully in all camp activities, including meals.
If I drive to camp, I will turn in my keys to the camp director.
In addition, I certify that I am registering for the right camp for my grade level.
I understand that serious violation of this covenant may result in being sent home,
and I or my parents (whichever is applicable) will be responsible for transporting me home should that occur.
*Smoking: 1) is unhealthy, 2) interrupts camp community by isolating individuals, and 3) represents a serious fire danger at C.G.C. Therefore, the Outdoor Ministries committee has decided that all regional camps at CGC will be smoke-free for all campers and staff (regardless of age).
Summer Camp is a Cell Phone Free Zone for campers. Cell phones, Internet hotspots, electronic entertainment devices, game devices, or devices capable of connecting to cell towers often detract from the camp experience. Youth bringing these items to camp are required to check-in the items on the opening day of camp. If I am found to have these items after the opening day of camp, I understand and accept that I may be sent home. Chi Rho and CYF camps may grant cell phone time for one hour per day.

You cannot register for camp, retreat, study trip, or mission trip experiences without agreeing to uphold the Community Covenant.

 List all drivers, including yourself, who are authorized to transport your child from home to camp:

List all drivers, including yourself, who are authorized to transport your child from camp to home:

NOTICE: THIS IS A LEGALLY BINDING AGREEMENT. Read this document carefully and in entirety. By signing this agreement, you give up your right and/or any named minor’s right to bring a court action to recover compensation or obtain any other remedy for any personal injury or property damage however caused arising out of your participation and/or the named minor’s participation in the camping program of the Christian Church (Disciples of Christ) of Northern California/Nevada Region at the Community of the Great Commission.

ACKNOWLEDGMENT OF RISK
I, in my legal capacity as the parent/guardian of the minor named above, and/or as a participant myself, do hereby acknowledge and agree that participation in any activities comes with inherent risks. I have full knowledge and understanding of the inherent risks associated with any activity or program participation, including but in no way limited to: (1) slips, trips, and falls, (2) aquatic injuries, (3) athletic injuries, and (4) illness, including exposure to and infection with viruses or bacteria. I further acknowledge that the preceding list is not inclusive of all possible risks associated with any activity or program participation and that said list in no way limits the operation of this Agreement.

CORONAVIRUS / COVID-19 WARNING & DISCLAIMER
Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing, mask wearing, and hand washing as a means to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in the Christian Church (Disciples of Christ) of Northern California/Nevada Region at the Community of the Great Commission programs or accessing facilities that host our programming could increase the risk of contracting COVID-19. The Christian Church (Disciples of Christ) of Northern California/Nevada Region at the Community of the Great Commission in no way warrants that COVID-19 infection will not occur through participation in the Christian Church (Disciples of Christ) of Northern California/Nevada Region at the Community of the Great Commission camping programs and the facilities that host our programming.

In consideration of your participation and/or the named minor’s participation in the Christian Church (Disciples of Christ) of Northern California/Nevada Region at the Community of the Great Commission activities and programs, I am the parent/guardian of the minor named above, agree to release and on behalf of myself and/or the minor named above, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE the Christian Church (Disciples of Christ) of Northern California/Nevada Region at the Community of the Great Commission, its officers, directors, employees, volunteers, agents, representatives and insurers (“Releasees”) from any causes of action, claims, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I, the named minor, my heirs, representatives, executors, administrators and assigns may have, now or in the future, against the Christian Church (Disciples of Christ) of Northern California/Nevada Region at the Community of the Great Commission on account of personal injury, property damage, death or accident of any kind, arising out of or in any way related to the use of facilities/equipment or participation in the Christian Church (Disciples of Christ) of Northern California/Nevada Region at the Community of the Great Commission programs whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees.

In consideration of my participation and/or the named minor’s participation in activities and programs, I, the undersigned parent/guardian of the named minor, agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to my program participation and/or the named minor’s activity and program participation.