CAMP31 Good Shepherd Summer Day Camp Registration 2022

CAMP31 Good Shepherd Summer Day Camp Registration Form – Summer 2022

REGISTER YOUR CHILD/CHILDREN:
At this point you should have already CREATED AN ACCOUNT! If you did not create an account, please go to MY ACCOUNT first.

Please complete the following form. You can register up to THREE (3) children with this form. For 4 or more children, please contact us for special instructions.

Note: You can save your progress at any time by scrolling to the bottom of the form and click “Save & Continue Later.”

If you do not see a form below, this means Registration is currently closed. Please contact Mark Schuler if you have questions or concerns.

Camp31 Good Shepherd Summer Day Camp 2022

Camper's Information
Camper's Name*
First Last
Gender*
- Male
- Female
Camper's Age*
Camper's Birthdate*
MM slash DD slash YYYY
Grade Enrolled - Fall '22*
Camper's T-shirt Size*
Please list all allergies, medical problems, and/or physical limitations of this camper:
Is camper under a physician's care and/or taking medication(s) for conditions related to his/her behavior?*
- No
- Yes
If yes, please share corrective alternative methods that have been the most successful when handling this camper and/or additional helpful information that you feel the camp staff should be made aware of about this camper relating to his/her behavior or state of mind.
Examples: fears, ability to share, reaction to hunger and/or fatigue, overall nature, etc.
Camper's Physician & Phone #:*
Camper's Dentist & Phone #:*
Do you want to register a second child?*
- No
- Yes
2nd Camper's Name*
First Last
2nd Camper's Gender*
- Male
- Female
2nd Camper's Age*
2nd Camper's Birthdate*
MM slash DD slash YYYY
2nd Camper's Grade Enrolled - Fall '22*
2nd Camper's T-shirt Size*
For 2nd Camper - Please list all allergies, medical problems, and/or physical limitations of this camper:
Is 2nd camper under a physician's care and/or taking medication(s) for conditions related to his/her behavior?*
- No
- Yes
If yes, please share corrective alternative methods that have been the most successful when handling this camper and/or additional helpful information that you feel the camp staff should be made aware of about this camper relating to his/her behavior or state of mind.
Examples: fears, ability to share, reaction to hunger and/or fatigue, overall nature, etc.
2nd Camper's Physician & Phone #:*
If same as Camper #1, just type "Same."
2nd Camper's Dentist & Phone #:*
If same as Camper #1, just type "Same."
Do you want to register a third child?*
- No
- Yes
3rd Camper's Name*
First Last
3rd Camper's Gender*
- Male
- Female
3rd Camper's Age*
3rd Camper's Birthdate*
MM slash DD slash YYYY
3rd Camper's Grade Enrolled - Fall '22*
3rd Camper's T-shirt Size*
For 3rd Camper - Please list all allergies, medical problems, and/or physical limitations of this camper:
Is 3rd camper under a physician's care and/or taking medication(s) for conditions related to his/her behavior?*
- No
- Yes
If yes, please share corrective alternative methods that have been the most successful when handling this camper and/or additional helpful information that you feel the camp staff should be made aware of about this camper relating to his/her behavior or state of mind.
Examples: fears, ability to share, reaction to hunger and/or fatigue, overall nature, etc.
3rd Camper's Physician & Phone #:*
If same as Camper #1, just type "Same."
3rd Camper's Dentist & Phone #:*
If same as Camper #1, just type "Same."
Parent Information
Mother's Name
First Last
Mother's Work Phone
Mother's Cell Phone
Mother's Employer
Father's Name
First Last
Father's Work Phone
Father's Cell Phone
Father's Employer
Home Address*
Street Address City State ZIP Code
Home Phone*
Primary Email*
Alternate/Second Email*
Emergency Contact #1 Name*
Other than parent. List in order of preference.
First Last
Emergency Contact #1 Phone*
Emergency Contact #2 Name*
Other than parent. List in order of preference.
First Last
Emergency Contact #2 Phone*
Preferred Medical Facility:*
Registration Section
Registration Package Section*
Applications will be processed based on the date the $50 per camper non-refundable registration fee is processed along with this application. Payment of this fee and submission of application does not guarantee a reservation for the CAMP31 2022 Summer Day Camp.

Platinum package – ALL 8 weeks | May 31 – July 22
Registration Fee = $50 per camper (non-refundable)
1st camper = $1,030 | 2nd camper = $1,010 | 3rd camper = $1,010

Gold package – ANY 7 of the 8 weeks | May 31 – July 22
Registration Fee = $50 per camper (non-refundable)
1st camper = $930 | 2nd camper = $910 | 3rd camper = $910

Only Select ONE Package.
- Platinum Package
- Gold Package
Gold Package - Week Off Selection*
Please choose only 1 of the 8 options. This is the week or tentative week your child will NOT attend camp.
- May 31 - June 3
- June 6-10
- June 13-17
- June 20-24
- June 27 - July 1
- July 4-8
- July 11-15
- July 18-22
Do you want to enroll in the Extra Innings Week?*
The CAMP31 Extra Innings Week is available ONLY to Platinum & Gold Package registrants.
Dates: July 25-29, 2022
Cost: $150 per camper (no discount for multiple children)
- Yes
- No
Media Consent*
I agree to the Media Consent.
I hereby grant CAMP31 Management, LLC (“CAMP31”) and their agents the absolute right and permission to use photographic portraits, pictures, digital images or videotapes of My Child(ren), or in which My Child(ren) may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any CAMP31 publication or on the CAMP31 website or on CAMP31 social media accounts, without payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein My Child’s likeness appears, or the use to which it may be applied.
CAMP 31 MANAGEMENT, LLC PARENTAL/LEGAL GUARDIAN CONSENT FORM AND RELEASE OF LIABILITY AND AGREEMENT TO INDEMNIFY*
I agree to the CAMP 31 MANAGEMENT, LLC PARENTAL/LEGAL GUARDIAN CONSENT FORM AND RELEASE OF LIABILITY AND AGREEMENT TO INDEMNIFY.
CAMP 31 MANAGEMENT, LLC
PARENTAL/LEGAL GUARDIAN CONSENT FORM
AND RELEASE OF LIABILITY AND AGREEMENT TO INDEMNIFY

In consideration of Camp 31 Management, LLC (hereinafter referred to as “Camp 31”) allowing the below-named minor child access to and use of its summer camp program and facility, including but not limited to: its on-site summer camp programs and off-site programs, teacher/ camp instructor supervision, care, transportation/travel and participation in any and all off-site programs (hereinafter referred to as the “Summer Camp Program and Transportation”), I, the undersigned, on behalf of the minor child and his/her heirs, next of kin, assigns, and personal representatives, do hereby agree to the following conditions:
I understand, acknowledge and agree on behalf of the minor child that access to and/or use of the Summer Camp Program and Transportation is potentially hazardous and involves risks, inherent, negligent or otherwise, that cannot be eliminated and which may cause injury, illness, paralysis or death to the minor child, other persons, and/or damage to property. Some of the risks associated with minor child’s access to and/or use of the Summer Camp Program and Transportation include, but are not limited to, equipment failure, known or unknown medical conditions, improper use of equipment, acts of others (including children), acts of instructors, counselors, teachers or supervisors, and latent or patent defects or dangerous conditions in the Summer Camp Program and Transportation, children that are not the same age as minor child will be present and involved in some activities minor child may participate in and that children who are not part of Camp 31 and the Summer Camp Program and Transportation may also be present at public facilities where minor child is also present and could negligently or otherwise cause injury, illness, paralysis or death to the minor child (hereinafter referred to as “Risks”). On behalf of minor child, I accept full and sole responsibility for all Risks, both known and unknown, inherent or otherwise, related to minor child’s access to and/or use of the Summer Camp Program and Transportation, and acknowledge that minor child is voluntarily using the Summer Camp Program and Transportation with knowledge of these Risks.
Acknowledging that such Risks exist, on behalf of minor child, I hereby RELEASE AND DISCHARGE Camp 31 and the Summer Camp Program and Transportation, its affiliates (including, but not limited to: Camp 31’s owners, managers, operators, the Summer Camp Program and Transportation teachers, instructors, counselors, supervisors, managers and any parties having contact with the minor child on behalf of Camp 31 and the Summer Camp Program) and/or anyone associated in any way with minor child’s access to or use of Camp 31 and the Summer Camp Program and Transportation from any and all claims, defenses, damages, losses, actions, suits, proceedings, Risks, expenses, attorney fees, costs, and liability that minor child, anyone on his/her behalf, his/her heirs, next of kin, assigns, beneficiaries or personal representatives might have for or relating to any injury to minor child’s person or property suffered or claimed to have been suffered by minor child which arises out of or is related in any manner to minor child’s access to or use of Camp 31 and/or the Summer Camp Program and Transportation, including, but not limited to, any claim that the act or omission complained of was caused in whole or in part by the strict liability or negligence in any form of Camp 31 or the Summer Camp Program and Transportation.

I further agree to INDEMNIFY, HOLD HARMLESS, AND DEFEND the Camp 31 and/or the Summer Camp Program and Transportation in any action or proceeding from and against all alleged medical debts, liability, claims, defenses, causes of action, damages, losses, suits, proceedings, Risks, expenses, attorney fees and costs arising out of or related in any manner to minor child’s access to or use of the Camp 31 and/or the Summer Camp Program and Transportation, my or for minor child’s failure to comply with the terms of this Release of Liability and Agreement to Indemnify. This agreement to indemnify, hold harmless and defend applies even if the act or omission complained of was allegedly caused in whole or in part by the strict liability or negligence in any form of the Camp 31 and/or the Summer Camp Program and Transportation.
This document is governed by the laws of the State of Indiana, and any cause of action relating to the interpretation or enforcement of this document is subject to the exclusive jurisdiction of a court in Vanderburgh County, Indiana. If one or more portions of this document are found to be unenforceable, it is agreed the remainder of the document will remain enforceable.
I have read and fully understand this Consent Form and Release of Liability and Agreement to Indemnify and agree to be bound by its terms. I understand that by signing this document I am waiving certain legal rights, including the right to sue the Camp 31 and/or the Summer Camp Program and Transportation. I sign this document freely and willingly.
Please Verify:
Comments
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Save and Continue Later

CAMP31 Good Shepherd Summer Day Camp Registration Form – Summer 2022

Camp31 Good Shepherd Summer Day Camp 2022

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