Camp Venango for Jesus 2025 Registration We are excited you want to be part of Camp Venango for Jesus! Registration Form: Name * Biological Sex * Male Female Grade Entering * 4 5 6 7 8 9 10 11 12 First time at CVFJ? * Yes No Date of Birth * MM DD YYYY T-Shirt Size (adult sizes only) * S M L XL Home Church (if applicable) Parent/Guardian Names * Parent/Guardian Email Address * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone * (###) ### #### Home Phone (###) ### #### Work Phone (###) ### #### Family Physician * Insurance Company * Insurance Policy & Group Numbers * Allergies/Health Concerns/Comments * Swim Status * Swimmer with NO life jacket required Swimmer with life jacket only Non-swimmer, shallow water only I do not want my child to swim Canoeing/kayaking ( a lifeguard will be present) * My child may participate in canoeing and kayaking My child may not participate in canoeing or kayaking Have you read this entirely and do you agree? * I hereby give permission for my child to participate in swimming and water activities as indicated above while at Camp Venango for Jesus. (If you desire your child to wear a life jacket when swimming in the pond – you must provide it.) I understand a lifeguard will be present for the activities and will take place at the ponds on the private property of the Keith Boyd family. I hereby give my permission for my child to attend Camp Venango for Jesus 2025. I give permission that he/she may be transported off the premises for pre-planned camp activities and agree to all camp policies. I also permit that a photo of my child be used for camp publicity. In case of medical emergency, I give consent for emergency treatment by adult personnel. I understand Common Grounds of Crawford County, Keith Boyd family, other staff/volunteers, and Camp Venango for Jesus assumes no liability for accidents which may occur while at camp. To the fullest extent permitted by law, the undersigned, individually and as parent and natural guardian of his/her/their minor child (hereinafter the “CAMPER”), and for the undersigneds and the minor’s representatives, executors, administrators, successors and assigns, do hereby agree to indemnify, defend and hold harmless CAMP VENANGO FOR JESUS (hereinafter referred to collectively as “CAMP”), its servants, agents, officers, directors, members, shareholders, employees, staff, volunteers, successors and assigns, from and against all claims, demands, damages, liabilities, causes of action, losses, costs and expenses, including reasonable attorney’s fees, of every kind and nature, whether or not covered by insurance, arising out of, resulting from or caused by, in whole or in part, any act, omission, fault or negligence on the part of the CAMP, its servants, agents, officers, directors, members, shareholders, employees, staff and/or volunteers, as well as any act, omission, fault or active or passive negligence on the part of CAMP, its servants, agents, officers, directors, members, shareholders, employees, staff and/or volunteers, in connection with this Agreement, including but not limited to those claims, demands, damages, liabilities, causes of action, losses, costs and expenses attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible property including the loss of use resulting therefrom. This obligation to indemnify, defend and hold harmless shall not be construed to negate, abridge or otherwise reduce any other right or obligation of indemnity which would otherwise exist as to any party or person described in this paragraph. Further, this obligation to indemnify, defend and hold harmless shall survive termination of this Agreement. Yes - I have read and I agree No - I have not read and do not agree Digital Signature - Type Your Full Name * By typing out your full name, you agree that all of the above information is true and correct to the best of your knowledge: Today's Date * MM DD YYYY Thank you for registering for Camp Venango for Jesus 2025!
