Camper Registration Form

This form has 7 sections. This section collects information about the individual Camper. Please complete all fields (mandatory if it includes an asterisk). If you are unable to complete all the sections in one setting, please use the "Save and Resume Later" option to complete the form later.

This section collects information on the Parent or Guardian. Please complete all fields with an red asterisk. If you wish to add a 2nd Parent or Guardian, please include their information at the bottom of this section. Adding a 2nd Parent or Guardian is not required.

Note: This section below is not required. You may include a secondary Parent / Guardian who can be contacted in case of emergency, and you cannot be reached.

The following information must be filled in by the parent/guardian, or adult camper.

If ** is indicated, please contact the director of the camper - Pastor Audrey Mangum @ (912) 432-3001 a minimum of 3 weeks prior to the session to assist us with our staff/ volunteer and cabin assignments. Please assist us so we can provide the best camping experience for your child!

Parent/Guardian Authorization: This health form is correct as far as I know and the person herein described has permission to engage in all camp activities except as noted on the back of this form. Health Care: I give the camp health officer permission to give me/my child over-the-counter and prescription medications in accordance with the standing orders approved by the camp physician . Permission to Treat: I hereby give permission to the medical personnel selected by the Camp Director to provide routine health care, to administer medications and to order X-rays, routine tests and treatment for me/my child, and in the event I cannot be reached in an emergency, I hereby give permission to the medical personnel selected by the Camp Director to hospitalize, secure proper treatment, review my/ my child's medical records, discuss my/my child's conditions with any medical personnel, and to order injection and anesthesia and/or surgery for me/my child as named above. This form may be photocopied for use out of the camp. This form is a HIPAA authorization release. Transportation Authorization: I give permission for me/my child to be transported in private vehicle if necessary. Additional Release: I release all photos, videos and audio tapes of me/my child to BORM to be used for promotional purposes. I acknowledge that post-camp meetings, reunions, and voluntary events are not conducted under the supervision or auspices/sponsorship of the BORM, which is not responsible for anyone's well-being at such events.

Release of Liability Urban Youth Alliance Michigan Annual Conference of the United Methodist Church The Urban Youth Alliance (UYA) offers a variety of voluntary activities, services and camping experiences. These may include, without limitation, providing food, lodging, and transportation, as well as challenging and educational activities associated with camping and the outdoors, such as hiking, boating, swimming, campfires, fishing, ropes courses, horseback riding, climbing and the like. Both campers and staff members, including volunteers, may have the opportunity to participate in one or more of these activities.

While the UYA tries to provide for the safety of its campers and staff members, there are unavoidable risks of injury and even death associated with camping and its related services and activities. Injury or death can occur even when care has been taken to provide for safety. Consequently, UYA requires that this Release of Liability be signed before anyone may attend a camp, or participate in camp activities, as either a camper or staff member.

If you are a prospective camper under eighteen years of age, one of your parents or your legal guardian must print his or her name below and then sign and date the line designated Signature of Parent or Guardian of Camper/Staff Member Under Age 18. If you are a prospective camper eighteen years of age or older, you must print your name below and sign and date the line designated Signature of Adult Camper.

In consideration of the opportunity to be involved in a camp and the related services UYA provides, the undersigned agrees as follows:

1. I have read and understand the risks summarized above;

2. I understand that participation in camp activities and receipt of UYA services is voluntary;

3. I expressly assume the risks of such attendance and participation;

4. For myself and on behalf of my representatives, administrators, heirs, successors and those I am responsible for, I fully and completely release, discharge and hold harmless the UYA, the Michigan Annual Conference of the United Methodist Church, and all Methodist affiliated camps I am involved in, including the owners, officers, directors, trustees, employees, agents, volunteers and affiliates of the same, from any and all claims, agreements, liabilities or suits, in law or in equity, arising in any way from involvement in or attendance at such a camp, including injury to my person or property, or death, except if caused by the gross negligence of these entities or individuals. This includes a waiver and release of the right to sue on behalf of a child by a parent or guardian.

This Release of Liability affects important legal rights. The signer acknowledges that he or she has been advised to read it carefully before signing. You are encouraged to consult an attorney if you have any questions about the meaning or effect of this document. In addition, you are encouraged to contact the BORM office at 1-800-334-0544 if you have any questions about the services, activities or risks at any camp. The signer acknowledges he or she has read this document, understands it, has had the opportunity to obtain advice from an attorney if wished and is relying on the signer's own judgment in signing it.

These questions are asked and will be strictly enforced by our camp staff for the safety and protection of your camper.