1. GENERAL PERMISSION: I understand and agree that this event is sponsored by Generations Ministries of the Grace
Communion International, and depending upon circumstances, and without limitation, may involve both:
(a) physical/athletic activities such as sports, hiking, camping, arts & crafts and,
(b) spiritual or religious activities, such as Christian living or education classes, religious worship services, and the like.
I give my permission for my child to engage in all such activities.
2. ACCEPTANCE OF EVENT CONDITIONS: I understand and agree to the condition of the event venue as de
scribed in the information provided. I give permission for my child to participate under these conditions
3. DISCLOSURE OF SPECIAL HEALTH CONDITIONS: The following is a list of my child’s special health conditions
and needs of which event staff need to be aware (list here such things as medications, history of seizures, motion
sickness, allergies, etc.
List any medications and dosage your child is currently taking.
*Do we have permission to administer basic first aid and/or over the counter medications? (Tylenol, Ibuprofen, Antihistamines, etc.)
If yes, are there any such medications you do not want your child to have?
4. RELEASE OF LIABILITY REGARDING SPECIAL HEALTH CONDITIONS: I submit that the above mentioned
special health conditions and instructions are needed for my child while at the event. I understand that, although event
personnel will seek to help accommodate these special conditions, such as by giving medications and/or by seeking to
take appropriate precautions, etc., nonetheless, by sending my child to the event with these special health conditions:
• I acknowledge that I understand the event is not equipped to monitor or supervise such special conditions or needs as
would the parent if he/she were present.
• I certify it is safe for my child to participate in all event activities notwithstanding the special conditions, and
notwithstanding any possible lapse in medication, or possible interaction with other people or circumstances that may
affect the special conditions.
• I release and indemnify the event from all claims and liability stemming from the special conditions, including, without
limitation, any claim, illness, or injury, resulting from the event’s failure to properly administer medicines for the special conditions, failure to recognize a situation which might be potentially harmful to a person with the special conditions, or failure to recognize the onset of an episode of the special conditions.
5. PERMISSION TO SECURE EMERGENCY SERVICES: I give permission to event staff to secure usual and
customary medical and/or legal services for my child if needed in an emergency circumstance at the event. I as
parent/guardian will be responsible for the costs of such services if not covered by my insurance.
6. INSURANCE COVERAGE: *My child is covered by medical insurance:
If yes, list the name of the insurance company:
and the policy number:
I understand that if my child has no health/accident/medical insurance coverage, I will be responsible for the payment of
all expenses which may be incurred due to treatment at the event of an illness or injury.
I understand that basic first aid services will be available and that adult supervision will be provided. My child
may receive emergency medical care from a physician or emergency facility in case I cannot be reached in an
emergency. I understand that I am financially responsible for any such medical treatments and guarantee full
payment to the attending physicians and/or medical institutions. I will not hold liable Fontainebleau State Park,
YES Summer Camp, Regional Youth Ministries, Grace Communion International or any other persons, specific
or general bodies, affiliated with this program. The medical information listed above is accurate, and my child
has permission to participate in all activities at YES Summer Camp unless specifically indicated above.
My INITIALS verify that I am in agreement with all information and conditons posted under CAMPER INFORMATION AND PARENT/GUARDIAN INFORMATION.*:
In the past, we have asked everyone to leave their portable music players at home. The purpose of
this policy is to minimize the distractions of our teens and preteens while they are at camp. Because
cell phones can become a distraction from the purpose of our camp, we are now asking that all
campers (teens and pre-teens) leave their cell phones at home. If parents need to reach their son or
daughter at camp, they may call the cell phone numbers below which senior staff persons will have
with them at all times and can easily reach your child. We appreciate your understanding. The phone
numbers are also on the back of the packing list.
Joy Cryer: (337) 397-7863 or Ginny Rice: (225) 205-2901
NOTE: If a parent would feel more comfortable having their child bring a cell phone to camp for safety
reasons, please say "yes" in the box below and then place your initials in the next box.
I understand that cell phones can be a distraction at camp and have discussed with him/her that the phone is to be used only to call me, and that he/she will request permission from a senior staff member prior to calling me. Any other use of cell phones is not permitted. Please inital if you answered "yes" to authorize your child to bring a cellphone to camp and agree with camp rules concerning use of cellphones.
If you answered "yes" please initial.
I would like to attend YES Camp because...(to be completed by camper)
As the parent or guardian of the applicant, I acknowledge that if I were to pay the entire camp fee, it would create a
financial hardship. Please type your name
Church Endorsement: (If you attend church, this section is to be completed by the SENIOR PASTOR, YOUTH
DIRECTOR, CHILDREN'S DIRECTOR or other CHURCH CONTACT PERSON. Completion of this section is not mandatory in order to be considered for the
Church Representative's Name:
Church Representative's Email:
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