Jr. High Day Camp Registration RM_StatsParent InformationParent InformationComplete a form for each camper attending CRC.First Name (Parent) *Last Name (Parent) *Address 1 *Address 2City *State *Zip Code *Email Address *Enter Parent Email AddressCell Number *Enter Parent Cell NumberHome NumberWork NumberCamper InformationCamper InformationFirst Name *Last Name *Address 1Address 2CityStateZip CodeBirthdate *Grade Fall 2023 *Select an option7th8th9thGender * Male Female T-shirt Size *Select an optionYouth SmallYouth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-LargeMedical InformationDoes the camper take medication? Either prescribed or or over-the-counter. *Does the camper have any allergies? *Please list any limitations or special needs we should be aware of. *Check any that apply: * Asthma Carries an Inhaler Diabetic Hay Fever Heart Problems Heat Exhaustion Hyperactivity Stomach Problems Sunburns Easily Acid Reflux None OtherDoctor's Name *Doctor Phone *Emergency Contact (Someone we can contact if you are unavailable) *Relationship to Camper? *Phone Number *Medical Consent and Release *Permission GrantedIn the event of a medical emergency, and I cannot be reached during my child’s participation at CRC, I give permission to the doctor selected by CRC to secure treatment, hospitalize, perform surgery, and prescribe medications as deemed necessary to protect my child's health and well-being. I also authorize CRC to administer any medication, whether brought by the camper or available here (such as acetaminophen, ibuprofen, or other non-prescription drugs) as deemed advisable by the camp staff or a doctor, and to administer first aid when necessary. Further, in signing this form, I hereby certify that I give permission for my son or daughter to participate in the camping program of CRC. I release CRC, its agents, employees, or representatives from all claims or actions from the above named minor child participating in camp.Liability WaiverI acceptIn consideration of my participation in any way in the events and activities of Christian Resource Center, the undersigned acknowledges, appreciates, and agrees that: The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, FOR MYSELF, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my participation; and willingly agree to comply with the programs stated and customary terms and conditions for participation. I HEREBY RELEASE AND HOLD HARMLESS Christian Resource Center; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), with respect to any and all injury, illness, disability, death, or loss or damage to person or property incident to my involvement or participation in these programs to the fullest extent permitted by law. I HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to my involvement or participation in these programs to the fullest extent permitted by law. I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant. By registering for camp, you are allowing CRC to use photographs and videos in promotional material.You are registering for Jr. High Day Camp 2023Registration Cost: - Jr. High Day Camp ($85) Payment may be submitted online or sent by mail. If paying by mail, choose "Pay Offline" and send check to: CRC 603 S K Road Giltner NE 68841Day Camp Registration *Select a payment method * Pay Offline Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.