C Bar N Camp/MWSB - Acceptiva

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for choosing to attend C Bar N Ministries Summer Camps this year. Students will be engaged in fun games, competitions, meeting other campers, and hearing the Good News of Jesus Christ!

The dates for each of our camp are:

Kids Camp (completed grades 2-5) | June 11-14, 2024

Junior High Camp (completed grades 6-8) | June 17-21, 2024

Senior High Camp (completed grades 9-12) | June 24-28, 2024

Leadership Training Program (completed grades 10-12) | June 16-21, 2024

Please note- if you choose to pay just the deposit to register, that deposit will be subtracted from your total payment. The remaining balance can be paid at Registration on the first day of camp.

C-N Camp Registration

Kids Camp - Full Payment

$215.00

Kids Camp - Deposit Only

$15.00

Junior High Camp - Full Payment

$225.00

Junior High Camp - Deposit Only

$15.00

Senior High Camp - Full Payment

$225.00

Senior High Camp - Deposit Only

$15.00

LT Program - Full Payment

$270.00

LT Program - Deposit Only

$15.00

Other Amount

2.63% Processing Fee

Total: $0.00

Registration Information

Name of Camper: *

Gender: *

Date of Birth: *

Address: *

City: *

State: *

Zip Code: *

Phone: *

Grade (just completed): *

Church Attended (if any):

Cabin Roommate Request (Limit 1):

We will do our best to accommodate roommate requests, but please note that only the first name listed will be prioritized.

Medical Information

Please include the date for each occurrence your child has had.

Appendicitis:

Asthma:

Diabetes:

Diphtheria:

Fainting Spells:

Heart Trouble:

Chicken Pox:

Epilepsy:

Hepatitis:

Measles-German/ Rubella:

Rheumatic Fever:

Whooping Cough:

Hernia:

Mumps

Pneumonia:

Scarlet Fever:

Tonsillitis:

Tuberculosis:

Typhoid Fever:

Measles- Hard:

Rubella:

Polio:

Others:

Please check here if all immunizations are current.

If shots are not current, please list what the child is missing?

Missing Immunizations:

Special Conditions
(Food Allergies, etc):

Special Medication:

(send with camper and have it given to camp nurse for dispensing)
Please list instructions or call us as camp time draws near:

In case of emergency, please contact

Emergency Contact: *

Relationship to Camper: *

Emergency Phone: *

Emergency Contact 2: *

Relationship to Camper: *

Emergency Phone: *

Parent/Guardian's Release:

We at C-N Camp wish to provide each camper with a safe and enjoyable time during his/her stay here. Campers may be involved in supervised activities including but not limited to climbing, hiking, swimming, tubing, dodgeball, and volleyball. Please sign below to give your permission for your camper to participate in these and other less strenuous activities. IN CASE OF EMERGENCY I hereby give permission to the physician selected by the camp to hospitalize AND secure proper treatment or surgery for my child as named on this document.

By checking this box, I agree to everything and give my consent to the above mentioned Parent/Guardian Release.

Waiver Agreement:

Please read carefully before signing. This is a release of liability and waiver of certain legal rights.

I acknowledge that the indoor Climbing Wall and Bouldering Room have inherent risks, hazards and dangers for anyone, that cannot be eliminated, particularly in a Climbing environment. I UNDERSTAND THAT THESE RISKS, HAZARDS AND DANGERS INCLUDE, BUT NOT LIMITED TO: known and unanticipated risks which could result in physical and emotional injury, paralysis, death, or damage to myself, to property, or to third parties. It is understood that such risks cannot be eliminated without jeopardizing essential qualities of the activity.

I understand the risks, hazards, and dangers of Climbing and have had the opportunity to discuss them with C Bar N Staff. I understand that these activities may require good physical conditioning and a degree of skill and knowledge. I believe I have that good physical conditioning and the degree of skill and knowledge necessary for me to engage in these activities safely. I understand that I have responsibilities. My participation in this activity is purely voluntary. No one is forcing me to participate and I elect to participate in spite of the risks. I AM VOLUNTARY USING THE SERVICES OF C BAR N CAMP WITH FULL KNOWLEDGE OF THE INHERENT RISKS, HAZARDS, AND DANGERS INVOLVED AND HEREBY ASSUME AND ACCEPT ANY AND ALL RISKS OF INJURY, PARALYSIS, OR DEATH.

Lastly, I, for myself, my heirs, successors, executors, and surrogates, hereby KNOWINGLY AND INTENTIONALLY WAIVE AND RELEASE, INDEMNIFY AND HOLD HARMLESS C BAR N CAMP, their directors, officers, agents, employees, and volunteers from and against any and all claims, actions, causes of action, liabilities, suits, expenses (including reasonable attorneys' fees) which are related to, arise out of, or are in any way connected with my participation in this activity, including, but not limited to, NEGLIGENCE of any kind or nature, whether foreseen or unforeseen, arising directly or indirectly out of any damage, loss, injury, paralysis, or death to me or my property as a result of my engaging in these activities or the use of these services or equipment, whether such damage, loss, injury, paralysis, or death results from negligence of C Bar N Camp or from some other cause. I, for myself, my heirs, my successors, executors, and surrogates, further agree not to sue C Bar N Camp as a result of any injury, paralysis, or death suffered in connection with my use and participation in the activities of the Climbing Wall and Bouldering Room.

I HAVE CAREFULLY READ, CLEARLY UNDERSTAND, AND VOLUNTARILY SIGN THIS WAIVER AND RELEASE AGREEMENT.

Waiver Agreement *

By checking this box, I agree to everything and give my consent to the above mentioned Waiver Agreement.

Printed Name: *

Billing Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *