Prime Timers 1 Spring 2023

Attendee 1

First Name *

Last Name *

Mailing Address *

City *

State * Select ...ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code *

Email *

Phone Number *

Home Church *

Church Address *

Church City *

Church State * Select ...ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Church Zip Code *

Pastor *

Emergency Contact Information

Emergency Contact Name *

Emergency Phone Contact *

Food Allergies/Sensitivities

The camp may not be able to accommodate some food allergies.

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.

A typed name is equivalent to a written signature.

Attendant's Signature *

Participation, Release, Waiver, & Indemnity Agreement

What to bring to camp: bedding, towels, toiletries, weather-appropriate casual clothing, Bible, spending money for Snack Shop

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

Code of Conduct: Guests must accept and get along with others. Guests 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 guest. Guests will refrain from touching others in any harmful or inappropriate way. Guests must pay attention to their surroundings and follow staff instructions in all activities. Guests will adhere to all safety rules and regulations given for each activity he/she participates in while at camp. Guests must inform staff if they are experiencing a problem with another guest or having other issues. Any violation of the Code of Conduct can be grounds for automatic dismissal. Refunds are not given when a guest 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.

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.

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.

Attendant's Signature *