Group. Leader. information

Transcription

1 2016 Group Leader information

2 Trinity Pines Conference Center contact info Director: Vincent Thomas Assistant Director: Bethany Shelton Camp Cell: Camp (You will send your participant list to this address at least 2 weeks before camp starts.) Your director or assistant director will you your housing specifics. If you haven t heard from us 5 days before camp...or if we ve been playing phone tag... please us! Housing Lodge style housing in Coleman, Johnson-Saunders, Coleman & KO White are dorm rooms with bunkbeds and a restroom in each room. There are hotel-type rooms as well in Brumley, Lee, Chain, and Adrion Lodge. Each has a queen bed and 2 sets of bunk beds with a private bath. Beds will be made. Towels are NOT provided. You might want to bring hand soap, paper towels, and shower shoes. Housing will be determined when we have received participant lists for the churches attending camp for the week. Please make sure to send in your participant grid no later than 2 weeks before camp! letters from home ATTN: CentriKid Camps Camper / Church Name 4341 FM 356 Trinity, TX Make sure you send all mail by Day 2 of camp, so that it gets to camp before your camper leaves!

3 CentriKid at Trinity Pines Conference Center Documentation Needed: Click CentriKid Participant Release Form boxes links for Please bring three (3) copies of this form along with copies of the parent s insurance card (front & back). Two of the copies must be notarized. At check-in, one copy will go to CentriKid, and another copy to Trinity Pines. The 3rd copy is to be kept in the possession of the church group leader in case of emergency. Transportation Policy This is required by Trinity Pines for each church, related to the use of golf-carts or vehicles on campus. Please bring one (1) copy completed to check-in. Medication Administration Authorization This is required by Trinity Pines for all adults and campers who bring prescription and non-prescription medicine to camp. All medications must be in the original container in a zip lock bag with this form in the bag. This form does not need to be completed if you aren t bringing any medications to camp. All medications will be turned in to the nurse at check-in. Statement of Compliance Please bring 2 copies of the Statement of Compliance. This is required by CentriKid & Trinity Pines for all adults and campers that are 18 & older. A sexual offender and criminal background check must be completed for each person. Each adult must also complete the Child Protection Training. A copy of each certificate must be attached to the letter. The test, background checks, and original of the certificate are to be kept on file at the church. Certificate of Completion for Child Protection Training Trinity Pines requires one (1) physical copy of each certificate for all adults and campers who are 18 and older. The original is to be kept at the church. The training is good for two years. This training can be done online (instructions below) or a training session can be led by the church leader (download training materials here) Here are your instructions for completing the Child Protection Training online: 1. Visit 2. At the top right, there is a box for you to enter a membership code. Enter this code (simply copy/paste): PHL57D and click SUBMIT. 3. Enter your personal information to create an account. >At this point, when you click Get Started the tool should take you directly to the specific training you need to complete. >The training is entitled Child Protection Training - Texas Camps 4. Complete all required training sessions and complete the assessment.

4 Archery track time wet descriptions & wild track times Archery - Learn how to shoot a bow & arrow and even practice on our foam targets Splish Art Studio - A combination of painting, Splash sculpting, & crafting Baseball - Learn various skills, drills, & games of baseball Adventure Basketball - Learn various skills, drills & games of basketball build it Build it - Creative hands-on building activities Cheernastics - A combination of cheerleading & gymnastics Drama - Learn what it means to be an actor and perform various skits Tennis Flag Football - Learn various skills, drills & games of football Outdoor Kitchen Chaos - Cook and create fun foods from various ingredients games Outdoor Baseball Games - Play some favorites like wiffleball, capture the flag, & ultimate Frisbee Sign volleyball Language - Learn the basics and performing a song through Sign Language Flag Foot Sign Language Creative Dance - Learn a creative movement and perform in front of camp No Boys Allowed - A girls only track where you discuss specific girl topics no boys allowed cheernastics track Tell the Weird Science Soccer - Learn various skills, drills, & games of soccer World Splish Splash - Fun and crazy games in the pool soccer Kitchen Chaos Creative Dance Weird Science - Fun experimental games & activities with safe ingredients art studio Bl times Trinity Pines Blast- Participate in water and other fun activities unique to Trinity Pines track times track times track times track times Trinity Pines Adventure- Participate in fun ropes and climbing activities unique to Trinity Pines Volleyball - Learn various skills, drill of volleyball Wet & Wild - An assortment of games involving water hoses, water balloons, etc * Tracks are subject to availability. Make sure campers know the sports tracks are for beginner to intermediate players. We will be teaching basic skills for each sport, so if you have an all-star, you might want to encourage them to try something new!

5 Archery Art Studio Baseball Basketball Build it Cheernastics Drama Flag Football Creative Dance Kitchen Chaos No Boys Allowed Outdoor Games Sign Language Soccer Splish Splash Tennis Volleyball Weird Science Wet & Wild Trinity Pines Blast Trinity Pines Adventure ($10) Archery Art Studio Baseball Basketball Build it Cheernastics Drama Flag Football Creative Dance Kitchen Chaos No Boys Allowed Outdoor Games Sign Language Soccer Splish Splash Tennis Volleyball Weird Science Wet & Wild Trinity Pines Blast Trinity Pines Adventure ($10)

6 As soon as you enter campus, you will see CentriKid flags and staff in matching blue shirts pointing you to where you will need to go for Check-In. What to eat & where to hang out The campus is beautiful and there are tons of things to do during hang time like canoes, the blob, hanging out at the pool, and heading over to the snack shack. It is open from 1-5 and sells drinks, chips, and candy. Prices range from $ There also will be a small snack shack open after worship.

7 SCHEDULE DAY pm Check-In Dinner 7 pm Opening Celebration 7:45 pm Team Time / Adult Gathering 9 pm Church Group Time 10 pm Head to Room 10:30 pm Lights Out Day am Breakfast/Time Alone With God 8:30 am I Can t Wait 9 am Team Time (Bible Study / Rec) 11 am Lunch 12:15 pm Team Time (Bible study/party) 1:30 pm Track A 2:30 pm Track B 3:30 pm Track C the Spot *OMC replaces Party on Day 4 4:30 pm Hang Time Dinner 7 pm Worship 8 pm Church Group Time 10 pm Head to Room 10:30 pm Lights Out Day 5 7 am Breakfast / Time Alone With God 8:30 am Team Time 8:45 am Adult Gathering the Spot 9:30 am Closing Celebration 10:15 am Churches Depart Day 4 Afternoon 12:15 pm Track A 1:15 pm Track B 2:15 pm Track C the Spot 3:15 pm Team Time ( Bible study & OMC prep) 3:50 pm OMC 5 pm Hang Time Bible close toed Shoes the Spot wear your color entering & completed 3rd=Yellow completed 4th=Green completed 5th=Blue completed 6th=Red Adult=Orange Encourage your campers to wear their color to OMC. Their grade is the one they just completed. Meetat thespot They will want to have a shirt that is their color for OMC! They can be purchased in the store or they can bring one from home. Schedule Note: Everyone has loved having smaller groups in Bible study (12-15 avg.), and the second Bible study time in the afternoon provides a perfect opportunity to reinforce the lesson and make meaningful life applications. Because the group size in the Party is smaller too, more kids from each church participated in stage games. Moving to 3 track times allows more kids to participate in the tracks that they wanted, and to stay engaged throughout the day. After taking your feedback, we moved Track Times to directly after Lunch and it worked great last summer. It gives kids more time to digest their lunch before going outside and also gives them more time to change into a bathing suit or the correct shoes for their track. On Day 4 we will run a slightly altered schedule in the afternoon to accommodate for OMC, but your Camp Director will handle all the details to make this happen.

8 To Do before camp Register for camp! recruit sponsors Bring 1 male sponsor for every 5 male campers and 1 female sponsor for every 5 female campers. You may bring students to be in the Team Assistant Program (see page 9). The cost is the same for Team Assistants as other participants. All sponsors must: Be at least 18 years old(unless part of the Team Assistant Program) Have completed background check Help enforce curfew and clean up of your group s housing Monitor dress code of your campers Encourage participation and promptness as well as set a great example for the kids FEbruary 15: $50 deposit due A $50 deposit for each reservation is required. All deposits are non-refundable and cannot be applied toward the balance due. Many churches collect monthly payments for camp from their parents, do fundraisers to cut costs, and have sponsorships through their church to help aid parents. Fundraising normally begins even before this deposit deadline. Many churches require the $50 deposit from parents when they sign their children up to go to camp. us special needs any needs that we should be aware of prior to camp to centrikid@lifeway.com. Please specify if it is a mobility, dietary, housing, or emotional/spiritual need. This could be anything that may affect housing or cafeteria needs. Please include the week and location that you will be attending camp. If you need a refrigerator for medication or any other form of special accomodations, let us know and we will do our best to make arrangements for you ahead of time May 1: Cancellation Deadline All cancellations after May 1 will incur an additional $50.00 fee for each person dropped. When this occurs, deposits cannot be applied toward your balance, so make any changes before May 1. Meet with Parents Have them bring a copy of their insurance cards (front & back) and the completed release form. Have a notary at your meeting so that release forms can be notarized. Only one form needs to be notarized, but you will want to bring a copy of that form with you (just copy them all after they are notarized). You will turn in the orginals to CentriKid during Check-In and will keep the copy. Make sure every participant has one, even sponsors. Share your plan for traveling to camp and returning home. Include lunch plans, times to drop off/pick up their camper, etc. Share camp address for letters from home (found on page 3). Collect photo and DVD orders ($6/group pic, $30/End of the Week DVD). There is a form for parents to fill out on page 15. Pass out and go over the Parent Packet (starting on page 13 or found online here) with parents. Get all release forms notarized and copied Sign statement of compliance After background checking all of the adult sponsors that you will bring with you, please sign the Statement of Compliance in this packet and bring it with you to Check-In at camp. complete any needed special attention cards We take special attention cards very seriously at camp. Any mobility, dietary, emotional/spiritual, or medical need that camp staff need to know about should be written on these cards and turned in during Check-In. Also, fill out a card for any camper who will have a birthday while at camp.

9 To d0... at least 3 weeks before camp: Pay Balance Final balance must be received 14 days prior to arrival at camp. If it is not, your group will be charged a one-time $75 late fee. Call us at CAMP123 about auto-pay options for LifeWay accounts or to put your balance on a credit card. Your male/female counts are locked in 3 weeks prior to camp. At this point, we will begin housing assignments and final preparation for your arrival. After this point, you may substitute individual campers, as long as male/ female counts remain the same. Please notify us of any last minute changes via our camp or camp phone. no later than 3 weeks before camp: your participant list your participant list (download here) to our camp address (page 3). We can t do housing until we receive this. Be sure to include correct male and female numbers (including sponsors) and let us know if there are specific campers who do or do not need to be in the same Bible study group. Prepare Your forms Turn in at Check-In (in this order): Notarized Release Form (for campers and adults -- found in Parent Packet) Track Time Cards Statement of Compliance Group Order Summary Keep: Copy of Notarized Release Form prepare, pack, and meet us at camp! We can t wait to see you! Be sure to take pictures of your campers having fun at camp and post them online or them to parents, so they can get in on the fun their kids are having at CentriKid! Let us know if there are any questions we can answer for you! Participant List Camp Nurse form Camp Nurse You can bring a certified RN or doctor with your group. Their spot is free. We only need one nurse per cycle of camp so sign up now! Check out for more information. Centrikid Policies Travel and Compliance Your church group is responsible for checking into the background of adult sponsors and signing the Statement of Compliance in this document. Remember to have the church s insurance and needed info for travel. The church is liable on the way to and from camp. Campers without personal insurance If a camper requires medical attention while at camp, the camper is responsible for the cost. If the camper does not have insurance, the sponsoring church will be the financially responsible party. If the medical attention is needed because of an accidental injury at camp, LifeWay provides a limited insurance policy that applies to those costs. Damages and keys Your church group is responsible to pay for damages to any facilites or Residence hall caused by your group. Normally, church groups are given two keys/room. Check out the location specifics page for how much lost keys cost at your location. Cell phones at camp Please have campers leave phones at home or turn them in so that the group leader can employ a check-out system, during meals, during hang time, and during the time between church group time and lights out each night. Cell phones will not be allowed at any other time for campers. Illnesses at camp Please do not bring campers with a fever or who are sick to camp. CentriKid Camps will work with church group leaders to handle cases of illness at camp on a case-by-case basis. We must ask that campers displaying flu-like symptoms be sent home for the safety of remaining campers. Bringing your own kids to camp Your kids, younger than the 3rd grade, are welcome to join their parent during programming since they are not allowed to participate in team time or tracks. If they need bed space and meals, the cost is full price. If they need no bed space or meals, there is no charge. Rising 3rd graders are welcomed to participate in normal camper activities at the discretion of group leaders and parents.

10 parent meetinghelp When should you have a meeting? Every group is different. You will probably want to have one around sign up time to promote and answer any questions that parents may have. You will definitely want to have one about two weeks before camp, covering the parent packet and getting forms turned in and notarized. You may feel the need to meet with parents somewhere in between those as well. Subjects you will want to talk about: Logistics Let them know what time to be at the church to leave and what time you ll be back. Are you stopping for any meals on the way to camp or the way back? (You may want to take up money from parents for this meal. Each child can have an envelope for their travel meals so they don t have to worry about saving enough of their camp spending money.) Parent Packet Walk through the parent packet with parents. Tell them about the camp schedule and what color team their camper will be. Remind them to pack a shirt of the camper s team color for OMC or to send money to purchase a t-shirt at the Camp Store. Share the packing list [make sure to include what type of bedding they need to bring, and don t let them forget to bring towels!] Also, remind them to write their child s name on everything! Talk them through how they can begin to pray for and with their kids who are attending camp and how they can start talking to their child about the training of our faith. track time info Remember that campers fill out track time cards before you get to camp. It will be a good idea to pass out the descriptions on pg 4 to parents, so they can help explain the tracks. You can have the campers fill out track time cards on the bus as you re going to camp, or whenever you choose. Check grades Take this time to double check with the parents which grades their children have just completed. We want to have the campers in the correct Bible study grade when they get to camp. Contact at Camp Give them your cell phone number, and also let them know your policy on cell phones and when they could call. There s time in the schedule during our afternoon and evening hang time they coud use to call. Give parents the address at camp. collect store orders Take up money for any group pictures, DVDs, Camper Care Packages, and Camp Store Cards. Group pictures [$6] - serious or funny Picture Orders are due on the First Night of Camp DVDs [$30] - includes all media show that week can be ordered before Day 5 of camp Camper Care Packages [$30] - includes all team specific items to get campers completely prepared for OMC. More information on page 14. Must be preordered by June 1st Camp Store Cards - available in increments of $5, $25, & $50. In the parent pack, there is a form that parents can fill out to indicate what they would like to purchase ahead of time [group pictures, DVDs, Camper Care Packages, and Camp Store Cards]. After you receive these forms from them, you will need to fill out this preorder form for the Camper Care Packages and Camp Store Cards. This will help us make sure we have exactly what you need when you get to camp! The preorder form must be filled out before June 1 st. If you miss this deadline, contact your camp director or centrikid@lifeway.com Paperwork Ask a notary to attend your meeting and notarize release forms after parents fill them out. Make a copy of each form before coming to camp. You ll turn in the original and keep the copy. Guests at CentriKid To ensure the safety of all of the campers, everyone must follow this checklist: At the beginning of the week, inform your Camp Director of any visitors who will be arriving at camp. This is for both safety of the campers and availability of space. Upon arrival, guests must call the camp cell phone number to arrange a meeting location to receive their visitor sticker and to sign in. The Director s number can be found on page 3 of this document. Camp Director/Assistant Director can point the visitors in the direction of their church group at that time or arrange a meeting with their church group s leader.

11 follow-up after camp The church van just rolled into the parking lot after a week of fun and ministry at CentriKid. Now what? Everyone knows that follow-up is important and we need to continue to connect with our kids after camp. However, often after the luggage is unpacked, the intentionality of camp can tend to fade into the background. How do you get your leader to grasp the reality of what they lose by simply marking camp as done on the calendar? Just one more hour could make a difference for your church and for the Kingdom! Follow-up after camp is something we ve learned that churches sometimes overlook, so we put together some practical tips to get you started. We generally see three levels of follow-up and some specific actions that are important in each level: 1: New Decisions Any camper who made a decision to follow Jesus or started asking questions about their faith needs follow-up. Even kids who have a supportive Christian family can struggle with what to do next. It s important to follow up with them in person and as soon as possible. This is a very pivotal time in their life. Meet with their family and take a copy of page 17 Questions for Dig Deeper in the Parent Packet with you. Let them know their child came home with a CentriKid Devotional book that includes four weeks of devotions that we hope will encourage the camper to grow in their faith and really learn what it means to spend time alone with God. Use the questions from camp in the Parent Packet, put the list on the refrigerator, and talk about them often. Write a hand-written note to the camper encouraging their decision or questions. Connect that kid to a teacher or small group leader for their age group. Plug them into other discipleship opportunities at your church, so they can make friends, get involved, and begin to grow spiritually. If possible, talk one-on-one with the kid every few weeks to encourage their decision/lifestyle. 2: Guests and Friends You may have brought kids who are visitors to your church and haven t really gotten plugged into the children s ministry. You also may have brought friends of kids in your ministry who attend a different church or maybe don t regularly attend any church. You can be the person to make them feel welcome and included and make sure the things they learned at camp don t fall through the cracks when they get home. Write a hand-written note to the camper to say thanks for coming and remind them that God is always with them, just like we learned at camp. Write a hand-written note to the parent. Include page17 Questions to Dig Deeper and let them know their child came home with a CentriKid Devotional book. Offer to visit or call to connect with them. Revisit your list of campers in two months...follow up with a note or call to those who have stopped coming. 3: regular attenders Kids who are regular attenders at your church are also in need of follow-up. Even if they are already following Christ, they need someone to come alongside them and teach them what it means to live their lives for Christ. Discipleship is such a huge part of their journey with the Lord and can be overlooked when all of the focus is on new attenders. Write a hand-written note to the camper to say thanks for coming and reinforce something from the week. Write a hand-written note to the parent. Include the Questions to Dig Deeper on page 16, let them know their child came home with a CentriKid Devotional book, and to thank them for their support. Some tips on follow-up Some churches will assign a group of campers to each Adult Sponsor. It works well with our 1 to 5 camper/adult ratio requirement. Using this model, one adult is responsible for following up with each of their specific 5 kids, regardless of the level they are on. You may also want to divide up your group and have a certain adult who does all of the Level 1 follow-up, another who does all of Level 2, etc. Use the model that works best for your group.

12 team assistantprogram What is it anyway? The Team Assistant Program is an option designed to give your most-trusted high school rising juniors and seniors or young college students a behind-the-scenes look at being a camp staffer while they act as a sponsor for your church group. In general, each church that participates brings two Team Assistants, but the number of TA s brought is ultimately left to the church group leader s discretion. Middle school students and high schoolers who are not at least rising juniors may not participate. What Will they do? Count toward your 1:5 adult to camper ratio and stay with your group. Attend staff meetings each morning to prepare for the day. Shadow a Team Leader (camp staffer) during the morning at Recreation. Help out with tracks in the afternoon. Get a good idea of what serving on camp staff is like, in case they want to apply one day. How do i sign them up? Register them just as any other camper or adult sponsor. Remember, they must be at least a rising junior or older. Identify them as Team Assistant on the Participant List that you turn in two weeks prior to camp. SPECIAL NOTES: Night 1 - Attend welcome meeting with your rec leader during adult gathering. Rec leader will go over talking points and let team assistants know their assignments for the week. Day 4 - Tracks take place at 12:15, 1:15, 2:15pm. At 3:15, team assistants should assist with OMC setup. During OMC, team assistants can help create energy and excitement! Day 5 - Eat breakfast with recreation leader if possible. Meet with recreation leader at 8:45am during the final adult gathering. Day 2-4 TIME ACTIVITY ASSIGNMENTS 7:40am Morning Staff Mtg Regular attendance required Time Alone with God, Schedule 8:30am I Can t Wait Greet kids, create energy, etc sit with church 9:00am Recreation With assigned rec staffer: refill coolers, assist rec leader 10:50am Rec Ends Help clean up rec, help set up SPOT & track times Lunch Eat with church group 12:15pm PM Bible Study Assigned Bible Study staffer, Assist & participate in activities 1:30pm Track A Assistant Track Leader 2:30pm Track B Assistant Track Leader 3:30pm Track C Assistant Track Leader 4:30pm Hang Time With Church Group Dinner With Church Group 7:00pm Worship With Church Group 8:00pm Church Group With Church Group 8:45pm Evening HT With Church Group 10:00pm Head to room With Church Group

13 Group Order Summary turn this in at check in Church Group Photo ($6) how many of each? serious End of Week Dvd ($30) how many? funny Camp Store Cards $5 $25 $50 Total Camper Care Packages: pre-order by June 1st Yellow Green Blue Red Y-Medium Y-Large Small Medium Large X-Large 2X-Large Y-Medium Y-Large Small Medium Large X-Large 2X-Large Be sure to Pre-Order all Camper Care Packages by June 1st. Click here to find the Order Form Y-Medium Y-Large Small Medium Large X-Large 2X-Large Y-Medium Y-Large Small Medium Large X-Large 2X-Large Church Name: Address: City: ST: Zip: Phone:

14 This camper has a need that CentriKid should be aware of: This camper has a need that CentriKid should be aware of: dietary medical mobility emotional/spiritual Concerns: dietary medical mobility emotional/spiritual Concerns: Turn completed cards in to the Camp Director or Assistant Director. Turn completed cards in to the Camp Director or Assistant Director. This has a need that CentriKid should be aware of: This camper has a need that CentriKid should be aware of: dietary medical mobility emotional/spiritual Concerns: dietary medical mobility emotional/spiritual Concerns: Turn completed cards in to the Camp Director or Assistant Director. Turn completed cards in to the Camp Director or Assistant Director.

15 Participant Form Page 1 of 2 Rev Oct 2013 Group Leaders: Bring ONE notarized copy of this document to registration and keep a photocopy for yourself to have with you in case of emergency at camp. YOU MUST attach a photocopy of insurance card (front & back). Church Information: CentriKid Venue: Name of Church: Group Leader: Group Leader s cell # at camp: ( ) Church Address: City: ST: ZIP: Camper s Info: Participant Name Age Date of Birth: / / Grade Completed (campers only): Address: City: ST ZIP In case of an emergency notify: Relationship to participant: Phone Numbers - Home: ( ) Work: ( ) Mobile: ( ) Other:( ) Medical Profile Generally, the participant s Health is: (Check One) Excellent Good Fair Poor If Fair or Poor, please explain the condition: List any medical difficulties which are currently being treated: Check any of the following that cause you problems & explain: Asthma Sinusitis Bronchitis Kidney Trouble Heart Trouble Diabetes Dizziness Stomach Upset Hay Fever List any medicines or substances to which you are allergic: _ List any previous operations or serious illnesses List any medications you are currently taking: List any special diet or special needs: Childhood Diseases: Chickenpox Measles Mumps Whooping Cough Other: Date of Tetanus Immunization: / / You MUST attach a photocopy of insurance card (front & back). If a camper requires medical attention while at camp, the camper is responsible for the cost. If the camper does not have insurance the sponsoring church will be the financially responsible party. If the medical attention is needed because of an accidental injury at camp, LifeWay provides a limited insurance policy that applies to those costs. Permission, Acknowledgements, Release, Indemnity My permission is granted for the camp or event director, church official, any camp or event staffer, or adult present or in charge of first aid, to obtain necessary medical attention in case of sickness or injury to me or my child. Also, I understand that as a Participant, I or my child may be photographed or videotaped during normal camp or event activities, and these photos/videos may be used for promotional purposes. I, the undersigned, do hereby verify that the above information is correct, and I do hereby release and forever discharge LifeWay Christian Resources of the Southern Baptist Convention, the CentriKid Camp Venue, the Church, camp or event sponsors and state conventions and their employees ( Released Parties ) from any and all claims, costs, demands, actions or causes of action, past, present or future arising out of any damage or injury in connection with my or my child s employment by or participation in this camp or event. I agree to indemnify the Released Parties for any and all claims, demands, damages, injuries, costs, suits or causes of action, past, present, or future, arising out of or caused by myself or by my child while participating in this camp or event or while on property leased or owned by any of the Released Parties.

16 Assumption of Risk. I am aware of the risks associated with participation in the above event and do hereby voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including death, that may result from participation in event activities. Page 2 of 2 Rev Oct 2013 Recreation The recreation programs at summer event venues strive to offer fun, safe, and challenging activities that engage the whole person body, mind and soul. Program staff are trained and as a team committed to your rewarding experience with safety as their highest priority. They have done everything possible to mitigate any risks involved in their recreation programs. However there are inherent risks to participation in recreation activities, including but not limited to, initiative games, high and low challenge course, outdoor education, paintball and aquatics (not available at every CentriKid venue). You could experience any of the following elevated heart and respiratory rates, uncomfortable group dynamics, climbing or descending unpredictable and possibly slick or uneven terrain, crossing narrow wires and logs, jumping, running, climbing/descending steep rock faces, traveling long distances in remote settings, carrying weight on your backs and shoulders, unforeseen forces of nature or weather, any of which could result in injury/illness that could result in loss of life, limb, and/or property. For more detailed information about the recreation programs offered at CentriKid Camp Venues, go to and follow the specific link to the camp venue s Group Leader Information. Understanding. I represent and acknowledge that I have completely read and understand this document and all its terms and all matters referred to herein, and I signed voluntarily as my free act and deed, that I have had an ample opportunity to obtain the advice of counsel and that, by signing this document, I understand that I am relinquishing legal rights and remedies that may have otherwise been available to me. I understand that this Waiver and Release shall be construed as broadly and inclusively as is permitted by applicable law and agree that if any portion of this document is held invalid, the remaining shall continue in full force and effect. To the extent the restriction on filing lawsuits is deemed unlawful, I agree to submit any Claims to a Christian conciliation/mediation organization for binding resolution. Affirmation. Participant affirms that he/she has not been convicted of nor received a deferred adjudication for: a misdemeanor or felony under any state or federal statute regarding crimes against persons, sexual offenses, or violent offenses under the Participant Name submitted on this document or any other name or alias. Copy to Camp Venue. It is understood and agreed that a copy of this form shall be treated as authentic and binding as the original and that a copy of same shall be provided to camp venue. Complete and sign below (participants who are minors per your state statute require Parent/Legal Guardian signature). Participant s Signature: (only if 19yrs of age or older) Date: / / Parent/Guardian Signature: Phone: ( ) Date: / / Notary Acknowledgement: State of County of On before me,, Notary Public, personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the state that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Notary signature: My commission expires:

17 Statement of Compliance: This form is turned in upon arrival at camp. The volunteering Adult Sponsors named below are known to the staff or recognized leadership of the participating church and the church knows of no reason why any should not serve as a sponsor for children and youth under the age of eighteen (18). The church confirms that it has taken reasonable steps to confirm that the individuals are not registered sex offenders by making inquiries to law enforcement officials or by checking (the National Sex Offender Public Website). Participating church warrants that it has used company to perform nationwide criminal background checks on all Adult Sponsors. Participating church warrants it has brought no Adult Sponsor not listed on this form. Names of all Adult Sponsors: For camps held in Texas, the sponsoring church attests that it has, in addition to the above referenced sex offender and criminal background checks, satisfied the requirements set forth by the Texas Department of State Health Services Rule , which can be found online at Church Name: Phone #: Address: City: ST ZIP Authorized Representative Signature Name Printed Date

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