Camp H.E.A.R. Long View Ranch September 1-3 2023
Camp H.E.A.R. Long View Ranch SEPTEMBER 1-3 2023
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Email *
Untitled Title
Family Name *
City, State *
Phone Number *
E-mail address *
How many (total) family members will be attending camp *
Please list the names and  relationships, of all family members attending camp and include ages for children. (please note registration is limited to two caregivers and siblings/children living in the same household.  Unfortunately due to the cost involved we are unable to host additional adults, friends, extended family etc...) *
Name and age of camper(s) with hearing loss who will be attending *
What hearing devices does your camper(s) use *
Required
Emergency Contact for your family ( Name and Phone Number of someone not attending camp with you)
Please list any food or drug allergies that camp staff should be aware of? *
Please list  any special health needs/health concerns that camp staff needs to be aware of?
Please list T-shirt sizes for everyone in your family *
How did you hear about Camp H.E.A.R.
How do you hope Camp H.E.A.R. will benefit your family?
Please read the Full Authorization and Acknowledgement and  Medical Consent and confirm below: Authorization and Acknowledgment: By signing this waiver and consent, I, the legal parent/guardian grant permission for myself/my children to participate in any and all supervised activities including but not limited to swimming, boating and fishing, guided horseback riding, at Waiting to Hear’s (“The Sponsoring Organization”) Camp H.E.A.R. at Young Life RockBridge (“The Center”) unless otherwise specified on the Family Medical Form or Camper Medical Form. I recognize and acknowledge the inherent risks that these activities may present for me/my children.I acknowledge that the possession or use of alcoholic beverages and illegal drugs are strictly forbidden. I understand the possession of any weapon (firearm, knife, explosives, etc.) is strictly forbidden on camp property.Because I acknowledge the risks of attending myself or allowing my children to participate, I agree to release and hold harmless The Center/The Sponsoring Organization and its founders, trustees, directors, officers, employees, agents, affiliates, volunteers and staff (“Staff”) from any and all injury claims of any other nature which may result from my/my children’s participation at and travel to or from The Center. I agree to indemnify and hold The Center/The Sponsoring Organization, Their Staff and other families at The Center harmless from any and all liability caused by myself/my children, whether or not intentional.I authorize The Center/The Sponsoring Organization to release my demographic information to supporting affiliates who help with the cost of my child attending camp.  Medical Consent: I give my permission for The Center to arrange for any necessary first aid, or transport to a medical facility for offsite emergency care for myself/my children while at The Center. I accept responsibility for the costs of all such medical treatment.  Photography/Video Release: In consideration of my/my children’s participation in Camp H.E.A.R., and without any further consideration from The Center/The Sponsoring Organization, I hereby grant permission to The Center/The Sponsoring Organization, staff and affiliates to utilize my appearance, performance or voice in any and all manner and media throughout the world for the purpose of promotion, reporting or publication. The Center/The Sponsoring Organization may use my/my children’s name, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such material. I understand that no royalty, fee or any other compensation of any kind shall become payable to me by reason of such release and use of any photograph/Video. It is the policy of Waiting to Hear not to use the full name of children in any promotional materials. Children are typically referred to by first name only or more commonly by a pseudo name assigned to the child to protect their identity.  I agree to allow a pseudo name to be used to ensure my child’s safety.  I also acknowledge that various news media may be on site during the camp. . *
Photography/Video Release: In consideration of my/my children’s participation in Camp H.E.A.R., and without any further consideration from The Center/The Sponsoring Organization, I hereby grant permission to The Center/The Sponsoring Organization, staff and affiliates to utilize my appearance, performance or voice in any and all manner and media throughout the world for the purpose of promotion, reporting or publication. The Center/The Sponsoring Organization may use my/my children’s name, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such material. I understand that no royalty, fee or any other compensation of any kind shall become payable to me by reason of such release and use of any photograph/Video. It is the policy of Waiting to Hear not to use the full name of children in any promotional materials. Children are typically referred to by first name only or more commonly by a pseudo name assigned to the child to protect their identity.  I agree to allow a pseudo name to be used to ensure my child’s safety.  I also acknowledge that various news media may be on site during the camp. *
COVID-19 Release:   The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. As a result, federal, state, and local governments and agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. We are doing everything we can to be compliant with all regulations and ensure your safety. We have put in place preventative measures to reduce the spread of COVID-19, but we cannot guarantee that you or family members will not become infected with COVID-19.By participating in programs, services, and activities of our Organization, you agree to the following: On behalf of yourself and your children, you hereby release, covenant not to sue, discharge, and hold harmless Young Life RockBridge and Waiting to Hear, their employees, volunteers, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any hosted or programmed event by this organization. *
I understand that space at camp is limited, and that registering online  is not a guarantee of a spot at camp.  You will be contacted shortly to confirm your family's status. *
Please list any special requests (cabin assignments, leaving early/arriving late  etc...)
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