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Registration

2. NATURE AND DURATION OF ACTIVITIES

June 22-30 address: Sacraments, Virtue talks, outdoor sports, swimming, bonfires, night games, outings, contact sports, team building dynamics. At Camp Eagles Cliff 27 Camp Road (along Waukewan Road) Center Harbor New Hampshire 03226

3. ACTIVITY SUPERVISOR(S)

Fr. Syrien Kermit LC, Mark Taylor and other Legionnaire and adult chaperones.

4. TRANSPORTATION

Not Applicable.

5. MENTORING

Participants may be offered mentoring, which is intended to help young people personalize the principles of Christian living that they receive at home and in club activities. Mentoring involves a private conversation with an adult conducted in plain view of others. When dealing with adolescents, confidentiality will be maintained to foster an openness of dialogue, but situations involving sexual abuse of a minor or threats to life or physical health will be reported to the appropriate authority and to the parents (except in those cases where the parent may be the alleged abuser).

6. REQUIREMENTS

The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section 10 below.

7. CONSENT

I/We hereby consent to the above-named child's participation in the activities described above including mentoring, and specifically request that he be allowed to participate in those activities. I/We warrant that I/We have full authority to legally consent to his participation in the activities described on this form, and all provisions contained herein.

8. AUTHORIZATION

I/We hereby authorize Camp Eagles Cliff to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by Camp Eagles Cliff in its promotional materials and for its promotional purposes associated with its nonprofit activities. This authorization shall extend to use of my/our child’s image and likeness on the website of Camp Eagles Cliff, or its successor in operation or affiliated organization(s) upon written consent of Camp Eagles Cliff. I/We understand that this authorization shall survive the end of my/our child’s participation in the activities referenced on this form.

9. INSURANCE

I/We understand that Camp Eagles Cliff does not carry any health insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my/our own insurance carrier; or (b) that I/We am/are personally financially responsible for any and all medical costs incurred as a result of the child's injury.

10. EMERGENCIES

If the above-named child requires any emergency medical procedures or treatments during the activities, I/We consent to the activity supervisor(s) taking, arranging for or consenting to such procedures or treatments in the discretion of the activity supervisor(s). For purposes of such procedures and treatments, my/our child's blood type allergies or other medical problems (if any) are listed below:
Authorization to administer medications
  • PRESCRIPTION MEDICATIONS must include signature authorization from the child's physician. Prescription medications will NOT be administered without physician consent.
  • OVER-THE-COUNTER MEDICATIONS require parent authorization only. Medications must be in the original labeled container (no baggies, foil, etc.). Pharmacists can provide a duplicate labeled container.
  • Parent/guardian must provide the medication, related equipment required and specific instructions. The child MAY NOT bring these materials to camp or Camp Eagles Cliff activities.
  • Medication changes or dosage changes must be noted on a NEW medication authorization form. It is the responsibility of the parent/guardian to inform the Camp Eagles Cliff Volunteer or any changes.
  • New medication or dosage changes will not be given unless a newly labeled container is provided.
  • Unused medication will be disposed of unless picked up within one week after medication is discontinued.
Medication will be administered as follows:
I authorize the administration of the above stated medication while following under these directions.

11. EMERGENCY CONTACTS

If, in the event of a medical or other emergency, I/We am/are unable to be reached by telephone at the numbers listed below, I/We authorize the activity supervisor(s) to attempt to contact me/us through the alternative emergency contacts listed below:
Contact name(Required)
Address(Required)

13. RELEASE AND INDEMNIFICATION (Camp Eagles Cliff)

I/We release and waive, and further agree to indemnify, hold harmless or reimburse Camp Eagles Cliff, the individual members, agents, directors, officers, employees, volunteers and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by Camp Eagles Cliff, or any of its individual employees, agents, volunteers, etc. in enforcing this indemnity provision) without limitation in time or amount, damages or injuries arising out of, during, or in connection with my/our child's participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of my/our child’s participation in the activities referenced on this form and shall have no limitation in time or amount.

14. INSURANCE

I/We understand that Camp Eagles Cliff does not carry any insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is covered by insurance through my own insurance carrier.

15. RELEASE AND INDEMNIFICATION (Camp Eagles Cliff)

I/We release and waive, and further agree to indemnify, hold harmless or reimburse Camp Eagles Cliff against any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by Camp Eagles Cliff or any of its owners, employees, agents, volunteers, etc. in enforcing this indemnity provision without limitation in time or amount, damages or injuries arising out of, during, or in connection with the child’s participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of my child’s participation in the activities at Camp Eagles Cliff referenced on this form.
I/​We have read and understand the above and agree to all terms and conditions contained therein.
By completing and submitting this Agreement and checking the “I agree” box, you are consenting to the terms and provisions, as well entering into this Agreement in electronic form. You hereby agree that the accompanying electronic signature is valid for all purposes, as defined by law.

CHAPERONE INFORMATION

Is dad coming to help as chaperone?

PERSON FILLING OUT THE FORM

Name of person filling out this form*(required)(Required)
We will be sending the registration confirmation and other camp updates to this email

REGISTRATION PAYMENT

*If siblings are coming, you can pay the reduced $100 fee for the second and other siblings (first sibling needs to be paid in full) *Counselors are charged a minimal fee of $100 *For check payments, please make checks out to Camp Eagles Cliff.

Partial scholarship

There is a partial scholarship option available for those in need, who have already contacted camp administration. If you believe you qualify, please state your case below: