Girl’s Overnight

Girl’s Overnight Registration

Date: June 21 to 22 | Ages: 12 to 14


  • CAMPER INFORMATION

  • Y = Youth Size
    A = Adult Size
    X = Extra Large
    XX = Double Extra Large
    *Note that adult sizes run larger in length than youth sizes.

  • FAMILY INFORMATION


  • EMERGENCY CONTACT INFORMATION


    This information must be different then the Father and Mother information. You must use someone else!

  • PAYMENT INFORMATION / AGREEMENTS

  • $0.00
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  • CHALDEAN YOUTH CAMP

    PARENT/GUARDIAN AGREEMENT FORM

    I would like for my child, whom is stated above under the CAMPER INFORMATION section, to participate in the Chaldean Youth Camp (CYC), owned and operated by Our Lady of the fields Camp and Retreat Center. I realize and agree that in order for my child to participate in the camp program, I must read the following terms and conditions of this agreement and voluntarily agree to those terms and conditions.

    I permit my child to participate in the camp program and assert that my child’s participation is entirely voluntary. As my child’s parent/guardian, I expressly acknowledge and agree that there risks, both inherent and unforeseeable, in the activities that my child will participate in during the camp program. These activities may cause sickness, minor injury, serious injury or even death. I also expressly acknowledge and agree that, even with safeguards in place, CYC cannot guarantee that my child will not incur any sickness, minor injury, serious injury or even death.

    MEDICAL AGREEMENT

    This health history is correct and accurately reflects the health status of the camper to whom it pertains. The person described has permission to participate in all camp activities except as noted by me and/or an examining physician. I give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a "need to know" basis with camp staff. I give permission to photocopy this form. In addition, the camp has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status. I give my permission for the camper whom I registered on this form, listed above under the CAMPER INFORMATION section, to recieve medical treatment if necessary.

    PUBLICITY WAIVER

    I give permission to Our Lady of the fields Camp and Retreat Center to take photographs and/or audio/video recordings of my child and to use them for educational, professional, and publicity purposes for Our Lady of the fields Camp and Retreat Center and its Community Partners.

    ASSUMPTION OF RISK AND WAIVER OF LIABILITY

    In consideration of my child participating in the camp program, I expressly agree to assume all risks and expressly waive, release, discharge and hold harmless Our Lady of the fields Camp and Retreat Center, its directors, officers, agents, employees, assigns, and any volunteers (altogether referred to as “Camp Parties”), from and against all liability for loss or damage of property or money, any sickness, injury (minor or serious) or death that my child may incur, or any claim of any kind, however caused, resulting from or related in any way to my child’s participation and involvement in this camp program.

    INDEMNIFICATION

    I expressly agree to indemnify and hold harmless Our Lady of the fields Camp and Retreat Center and all the Camp Parties from any liability to myself, my child or any third party, resulting from or in any way relating to my participation and/or my child’s participation in the camp program.

    AGREEMENT NOT TO SUE

    I expressly agree not to sue Our Lady of the fields Camp and Retreat Center and all the Camp Parties for any claim, present or future, that I may have on behalf of myself or my child, that may result from or in any way be connected to, my participation or my child’s participation in the camp program.

    SEVERABILITY

    I expressly agree that the above-mentioned Assumption of Risk, Waiver of Liability and Agreement Not to Sue are intended to be as general and wide-ranging as is allowed by the laws of the State of Michigan. If any provision of this agreement or any part of any provision of this agreement is held invalid, illegal or unenforceable under Michigan law, the remaining parts and/or provisions shall not be affected or impaired in any way.

    I understand the terms and conditions of this agreement. I acknowledge and agree that this agreement is binding upon my heirs and assigns. I expressly and voluntarily agree to all terms and conditions contained in this agreement. By selecting the checkbox below, I verify that I have read thoroughly all the contents of this agreement and hereby agree to all that is stated.

About Us

“Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these.” Matthew 19:14

Address

1391 Kellogg Rd.Brighton, MI 48114

Contacts

Office hours: 9:00am – 5:00pm Telephone: (248) 379-0943Email: info@ourladyofthefieldscamp.com
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