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Register Parental Consent
Cross Roads Release of Liability for Minors I, the undersigned, am the parent or legal guardian of _____________________________ (minor’s name) and I am voluntarily allowing ______________________________ (minor’s name) to participate in a retreat sponsored by The Capital District of UMC on June 27-July 1, 2016; at the Cross Roads Retreat and Conference Center Inc., a Texas non-profit corporation. I understand and agree that ____________________________ (minor’s name) will be participating in a program and residing at the camp facility where the program is held. In consideration of the service, training, transportation and accommodations provided to me by the participants, directors, officers and members of The Capital District UMC, I hereby release the Cross Roads Retreat and Conference Center Incorporated and its officers, directors, members, volunteers and participants from any and all liabilities, claims, causes of action or damages which I might claim for injuries or damages suffered or sustained by ________________________________ (minor’s name) during or after the event. This release is binding on me and my heirs, devisees, and legal representatives.
I further authorize an adult, designated by Son Days Camp, in whose care the minor has been entrusted, to consent to any medical treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any licensed physician. I agree to be liable and agree to pay all cost and expenses incurred in connection with such medical services. I also give permission for my child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in the above event. In no way shall I hold the Cross Roads Retreat and Conference Center, Inc., Capital District UMC or Rio Texas Annual Conference of the United Methodist Church and its representatives accountable for any injury and/or subsequent expense incurred by the participant By signing below, I acknowledge and accept the risks of injury associated with participation.
Date_____________________________________
Signature_________________________________
Printed Name_____________________________
June 27 – July 1, 2016
Summer Overnight church Camp
At Cross Roads
Retreat in Caldwell, Texas
for children entering
3-5th grade
Camper Name:_______________________________Birth Date:___________Male: □ Female: □ Grade:_______ Camper T-shirt size: □ Child Small □ Child Medium □ Child Large □ Adult S □ Adult M Permission to use child photo for media or Facebook “Son Days Camp 2016” Group: Yes or No You may request to join the private Facebook Group: “Son Days Camp 2016” to follow camp activities during the week of camp. Home Phone:________________________ Camper Cell Phone:__________________ Parent Name:________________________ Email:______________________________ Parent Cell Phone: ____________________ Address:_____________________________ City:________________________________ Zip:____________ Allergies:__________________________________________________________________ Medication (prescription and over the counter medications must be labeled and checked into camp nurse upon check in): _______________________________________________________________________________________________________________ Insurance Company____________________________ Name of Primary Insured________________________ Group Policy #__________________ Social Security # of Primary Insured_________________________ Chronic/Acute Illness:____________________________________________________________________ Persons to notify in case of emergency: 1.Name:_____________________________Relation:____________________________ Phone:______________________________ 2.Name:_____________________________Relation:____________________________ Phone:______________________________
Camper Covenant
“But if we walk in the light, as He is in the light, we will have fellowship with one another, and the blood of Jesus, His Son, purifies us all from sin.”
1 John 1:7
a week of fun in the Son!
Arts, crafts, water balloons, worship, along with fellowship and activities using the many amenities of Cross Roads will sure to be a memorable and rewarding experience for your child.
Our camp counselors have all been trained by standards set by the State of Texas and the Rio Texas Conference of the United Methodist Church. Our aim is to create an atmosphere of inclusiveness and guidance to set as example the lessons that Jesus taught us in a serene and nurturing setting. Each day children will be able to select small group activities such as arts or sports and will begin and end with large group time of worship in either indoor or outdoor sanctuary.
Camp Directors are Martha Calhoun, Children’s Ministry Coordinator of the Capital District UMC/Children’s Director at Bee Creek UMC and Kristen Hillert, Children’s Director at Servant Church, Austin.
Contact: [email protected] Capital District Office 512-444-1983 The Cross Roads Retreat Center 1-979-567-7974 www.crossroadsretreat.org
In signing this covenant, I agree to live by the following guidelines listed below during this event in order to fulfill the purpose of our retreat.
1. Respect the health of my own body by refraining from the possession and/or use of alcohol, tobacco, and drugs of any kind, except those prescribed by a physician given to me by the camp nurse.
2. Respect the physical and emotional well being of other children and adults by “doing unto them as I would have them do unto me” (respecting the need for sleep, refraining from harmful practical jokes or inappropriate language, using electronic devices during designated times only).
3. Respect the property of the Crossroads property, students, and staff.
4. Be responsible for my own behavior and participate fully in all scheduled activities.
I understand:
1. A violation of any rule of the retreat may result in being asked to depart from the camp early. It is the responsibility of the participant to arrange transportation if asked to leave the camp.
2. A Director may have the right to request a search of my belongings. Failure to allow such a search may result in early departure from the retreat.
Parent Signature:__________________________ Camper Signature:___________________ Date:______________________________
Mail completed forms and registration fees to: Capital District of the United Methodist Church Attn: Martha Calhoun 1221 Ben White Blvd. Ste. 201-A Austin, TX 78704 Registration Deadline: June 1, 2016 Camp Cost: Before May 1: $290 After May 1: $310
Parents must fill out the Son Days Camper
Registration form and Parental Consent and Release of Liability form for each camper.
We are asking for adult/youth (15 years and up) volunteers to attend the camp. Please email Martha
Calhoun by May 1 if you are interested: [email protected]
□ I will contribute to send a camper on full scholarship: $__290_.
□ I will contribute for a partial scholarship:$_________ *Camp Scholarships are available on a need basis. For more info Email: [email protected]
