This form is for parents or guardians who could not sign the camp agreements during online registration. Please complete all four sections below, fill in the camper and parent/guardian information, sign and date the bottom, and submit the signed copy to the Cedine Camp Office at or before drop-off day. The camper cannot participate without this signed form.
Camper Name
Camp Name & Week
Parent / Guardian Name
Phone Number
1. Cellphone / Electronics Agreement
In this technology age it is difficult for you and your child to not be in contact via cell phone. Camp is a unique environment. We are trying to help youth develop life skills at camp including independence and self-reliance. Oftentimes homesickness, which is a normal part of a week at camp, can be worsened by talking to mom and dad. We respect and appreciate the wonderful relationship youth and families have, but if your campers are to enjoy the camp fully they must be able to develop this independence.
Campers are not allowed to bring cell phones or any other electronic devices to camp. If a cell phone or other electronics are brought with a camper they must be turned into the Camp Office upon arrival. Campers do not have access to camp phones. If there is an emergency or we are concerned about the youth’s well-being, parents will be contacted.
Acknowledgement
I understand that campers are not to bring cell phones or other electronics to camp and agree to the above terms.
2. Camper Agreement
Acknowledgement
I agree to abide by all the camp policies and any restrictions my parents have stated.
3. Parent / Guardian Authorization
The above information is correct to the best of my knowledge. He/she has permission to engage in all camp activities except as noted. I hereby give permission to the medical personnel selected by the camp health care staff to order x-rays, routine tests, treatment and necessary transportation for my child. In the event I cannot be reached in an emergency, I hereby give my permission to the doctor selected by the camp health care staff to secure and administer treatment, including hospitalization for my above-named child. I further release Cedine from all liability beyond the accident insurance carried by the camp. Furthermore, I understand that pictures will be taken during my child’s time at camp, and I give my permission for the use of such pictures containing my child’s likeness (and/or my likeness) for the promotion of Cedine’s camp or conference ministry.
Acknowledgement
I have read and approve the parent/guardian authorization.
4. Refund and Transfer Policy
All deposits are non-refundable. Remaining registration payments may be refunded at Cedine's sole discretion. Cancellation requests must be submitted in writing.
Acknowledgement
I have read and understand the refund and transfer policy.
5. Liability Assumption Waiver
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my participation at Cedine. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless Cedine, its 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 represent that I have adequate insurance to cover any injury or illness I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or illness myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume - and bear the costs of - all risks that may be created, directly or indirectly, by any such condition.
By signing this document, I agree that if I am injured or contract covid during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.
I have had sufficient time to read this entire document. I have read and understood this document and I agree to be bound by its terms. Refusal to sign will prohibit entrance into camp.
PARENT OR GUARDIAN ADDITIONAL AGREEMENT
(Must be completed for participants under the age of 18)
In consideration of the above-named minor being permitted to participate in this activity, I further agree to indemnify and hold harmless Releasees from any claims alleging negligence which are brought by or on behalf of minor or are in any way connected with such participation by minor.
Acknowledgement
I have read, understood and agree to abide by the liability assumption waiver.
Signature
By signing below, I confirm that I have read, understood, and agree to abide by all five agreements above — the cellphone/electronics agreement, the camper agreement, the parent/guardian authorization, the refund and transfer policy, and the liability assumption waiver — on behalf of myself and my camper.
Parent / Guardian Signature
Date
Printed Name
Relationship to Camper
Camper Signature
Date
Submit this signed form to: Cedine Camp Office, 333 Cedine Camp Road, Spring City, TN 37381 — or hand to the Camp Office on drop-off day. Questions: camp@cedine.org or 423.365.9565.