July 14, 2020

Attendee 1

First Name *

Last Name *

Date of Birth (mm/dd/yyyy) *

Gender * Select ... Male Female

Mailing Address *

City *

State (abbreviation; e.g. VA) *

Zip Code *

Email *

Phone *

Home Church *

Church Address *

Church City *

Church State *

Church Zip Code *

Church Phone *

Pastor *

Youth Pastor

Church Coordinator for this Event

Cabin Mate Request

Emergency Contact Information

Emergency Contact Name *

Relationship *

Emergency Phone Contacts (Day) *

Emergency Phone Contacts (Night, if different than Day)

Medical Information

On March 11, 2020, The World Health Organization declared the novel coronavirus, COVID-19, a pandemic. COVID-19 is highly contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people over the past several weeks. Rapidan Baptist Camp and Conference Center (the “Ministry”) has put precautions in place to reduce the spread of COVID-19; however, the Ministry cannot guarantee that you or your family, including your child(ren), will not become exposed to or infected with COVID-19. Further, because of the number of individuals involved in summer camp and the fact that many infected individuals appear to be asymptomatic, attending this activity could increase your and your child(ren)’s risk of contracting COVID-19. By signing this waiver, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19. I also acknowledge that by attending Rapidan Baptist Camp and Conference Center, such exposure or infection may result in personal injury, illness, disability, and/or death. I understand that the risk of becoming exposed to or infected by COVID-19 at Rapidan Baptist Camp and Conference Center may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Ministry employees, contractors, volunteers, members, and participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense of any kind that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Ministry or participation in Rapidan Baptist Camp and Conference Center (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Ministry, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Ministry, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any program.

Parent/Guardian's Signature

Health or Behavioral Conditions

Food Allergies

Drug Allergies

Other Allergies

Medications Taken Regularly (must be in original container)

Activity Restrictions

The Camper (Adult/Child) registering on this form is immunized against the following according to H.H.S. standards: Polio, Measles, Mumps, Rubella, Diphtheria, Tetanus, and Whooping Cough. (Please notify the camp if this child has been exposed to any communicable disease during the past two weeks prior to camp attendance.) If the Camper is not immunized, please download, complete, and submit the Immunization Waiver.

Print Immunization Waiver

Date of Last Tetanus Shot

Insurance Co.

Policy No.

Camper/Sponsor is Not Covered by Insurance

Parent/Guardian Information

I understand that my personal insurance will provide coverage for medical aid to me, my spouse, my child, and/or any dependents. I also understand that if me, my spouse, my child, and/or any dependents must be sent home because of disciplinary or other problems, there will be no refund and I will assume all additional costs incurred.

IN CASE OF MEDICAL EMERGENCY, I hereby give permission to the physician selected by the camp director or his agent to hospitalize, secure proper treatment for, and order injection, x-ray, anesthesia, or surgery for my child (or the minor) as named previously.

Parent/Guardian's Name *

A typed name is equivalent to a written signature.

Parent/Guardian's Signature *

Participation, Release, Waiver, & Indemnity Agreement

What to bring to camp: Bible, pen, flashlight, bedding, towels, toiletries, pool shoes/sandals, swimsuit (one-piece swimsuit for girls), sports clothes for activities, casual dress clothes for evening services, spending money for camp store.

What NOT to bring to camp: fireworks, weapons, knives, illegal drugs, tobacco products, vape items, alcoholic drinks, cell phones, tablets, clothing with worldly advertisements, vulgar or graphic expressions

Parents are responsible to make sure their child understands the guidelines and the morality standards of the camp found on the camp's website at www.camprapidan.com.

Dress Guidelines: We ask that all clothing be loosefitting and reach the top of the knee. Tank tops and clothing with worldly advertisements will not be permitted. The camp reserves the right to ask any camper or adult not following these guidelines to change their attire. For evening services, we ask that all campers clean up and wear casual dress clothes.

Code of Conduct: Campers must accept and get along with others. Campers will be expected to edify others. Language and actions that do not edify can be cause for dismissal. Name calling, foul language and practical jokes will not be tolerated from any camper. Campers will refrain from touching others in any harmful or inappropriate way. Campers must pay attention to their surroundings and follow staff instructions in all activities. Campers will adhere to all safety rules and regulations given for each activity he/she participates in while at camp. Campers must inform staff if they are experiencing a problem with another camper or other issues. Any Violation of the Code of Conduct can be grounds for automatic dismissal. Refunds are not given when a camper is dismissed from the program.

While we make every effort to provide a safe and pleasant environment for every camper who attends Rapidan Baptist Camp, we do require that this participation agreement be read, filled out, signed and dated by all campers (and their parent/guardian if under the age of 18) who wish to participate in activities at Rapidan. By signing this form, you acknowledge that you have read the form in its entirety and agree that you, your spouse, and/or your child will abide by the following terms while at camp.

Although Rapidan Baptist Camp has taken reasonable steps to provide equipment and skilled employees so yourself, your spouse, or your child can participate in activities for which he/she may not be skilled in, we do remind you that these activities are not without risk. Certain risks cannot be eliminated due to our camp’s rural setting and without destroying the unique character of those activities. The same elements that contribute to the character of these activities can be cause of loss or damage to your property, accidental injury or illness or, in extreme cases, permanent trauma or death. We do not want to frighten you or reduce your enthusiasm for these activities, but we do think it is important for you to be informed and know in advance about inherent risks.

Waiver: I, on behalf of myself, my children, my assigns and my estate, agree to release and hold harmless Rapidan Baptist Camp, its officers, board, agents or employees, for any and all claims for injuries, causes of action, or liability related to my child’s participation in any activity occurring at Rapidan. This release does not apply to intentional and/or willful acts of misconduct by Rapidan Baptist Camp or any of its officers, board, agents or employees. I give permission for my child to participate in activities that occur at Rapidan. These activities may include, but are not limited to, swimming, canoeing, zipnline, rail ride, archery, riflery, paintball, and strenuous competition games.

Should Rapidan Baptist Camp, or anyone acting on their behalf, be required to incur attorneys’ fees and costs to enforce this agreement, I agree to indemnify and hold Rapidan Baptist Camp harmless for all such fees and cost.

For promotional or marketing purposes, Rapidan reserves the right to use any audio, video, and/or photography of guests or campers participating at Rapidan Baptist Camp facilities.

By signing this document, I acknowledge that if anyone is hurt or property damaged during my or my child’s participation in these activities, I and/or my child may be found by a court of law to have waived any right to maintain a lawsuit against Rapidan Baptist Camp on the basis of any claim which has been released herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and agree to be bound to its terms.

A typed name is equivalent to a written signature.

Camper's Signature *

Parent/Guardian's Signature *