Retreat Registration Form

Must have a completed registration form for EACH camper attending. The cost of the Jr. Retreat will be $55/person and the cost of the Teen Retreat will be $80/person.

Please place a check after the weekend your child plans to attend:

Junior Retreats are $55/person

Teen Retreats are $80/person

Fall Retreats:

Junior (October 27-28, 2023)

Teen (November 3-5, 2023)

My child would like to be in the same cabin with:
(This does not mean that your child will be able to be in the same cabin as requested. Decisions are made according to number of campers, counselors, beds, etc.)

Emergency Contacts

You or someone listed below MUST sign out your camper on day of departure from retreat.

ID's must be shown prior to release of the camper.

YOUR CHILD WILL NOT BE ALLOWED TO GO WITH ANYONE WHO IS NOT ON THIS LIST.

Health Information

Does your child have allergies?

Does your child have diabetes, epilepsy, earaches, asthma, headaches, chronic stomach aches, bedwetting, or other?

Is your child on medication?

Is your child allowed to have "over the counter" medication, if needed?

NOTE:

All medication MUST be brought in original containers with original labels and given to the camp nurse at registration.

Rules for acceptance in the camping program are the same for everyone without regard to race, color, national origin, or gender.

Cancellations: Please notify us immediately so that a camper on the waiting list can be contacted

PARENT MEDICAL AND LIABILITY RELEASE STATEMENT

I understand that in the event medical intervention is needed, every attempt will be make to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency during the activity dates shown on this form, I hereby give my permission to the physician or dentist selected by the camp director, camp nurse, or ministry director to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.
I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. Coverage by Bancroft Gospel Ministry through its accident policy will be used as a back up for what my family's insurance does not cover.
I understand all reasonable safety precautions will be taken at all times by Bancroft Gospel Ministry and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Bancroft Gospel Ministry, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries, incurred by the subject on this form.
On behalf of yourself and your children, you hereby release, covenant not to sue, discharge, and hold harmless Bancroft Gospel Ministry, its employees, 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 Bancroft Gospel Ministry reserves the right to discipline or dismiss my child from camp with forfeiture of fees if he/she is non-cooperative or non-compliant.
I further agree to indemnify and hold Bancroft Gospel Ministry harmless against any and all costs, damages, and expenses which may be incurred by them as a result of any claim I may make, actions I take against the camp, or lawsuits I may file against them.
I give permission for my child's picture to be used in future camp publications, promotional videos and/or on the internet or social media.

By typing my name, I agree with the above Parent Medical and Liability Release Statement

Thanks for submitting!

RETREAT REGISTRATION FORM